Metabolomic Profiling of Erector Spinae Plane Block* for Breast Cancer Surgery
Condition: Breast Cancer
MeSH terms: Breast Neoplasms
Study type: Observational

Summary: 
      Worldwide, breast cancer is the most common cancer among women, and its incidence and
      mortality rates are expected to increase significantly in the next years. It remains a major
      health problem. There is a vast area on breast cancer and immunity that still needs to be
      researched. Do anesthetic techniques and medication preferences effect immune responses? If
      so how they effect breast cancer outcomes is unclear.

      On this trial, the investigators are searching anesthetic techniques affect on inflammatory
      and immune responses.
    

Detailed description: 
      Breast cancer is the most frequently encountered surgery among all cancer surgeries. Although
      it is a well known procedure for anesthesiologists, it is still unclear whether
      anesthesiology effects immune responses. Cancer therapies often use immune therapies such as
      Bevacizumab (a monoclonal antibody which targets Vascular Endothelial Growth Factor),
      Trastuzumab(a monoclonal antibody for Herceptin (HER2/Neu) mutation) how anesthetics effect
      VEGF stays unclear.

      Opioids are commonly used to provide analgesia for cancer pain, and functional opioid
      receptors have been identified on natural killer (NK) cells, the lymphocytes responsible for
      surveillance and elimination of cancer cells.[4] Anesthesiologists have well founded concerns
      about using morphine during cancer surgeries.

      Regional anesthetic techniques commonly used on cancer surgeries.The activation of sensory
      neurons during pain enhances tumor progression and metastatic potential. Regional anesthesia
      blocks somatic nociception and inhibits sympathetic preganglionic outflow (functional
      sympathectomy) during surgery. Moreover regional anesthesia, by blocking sympathetic nervous
      system output, induces a prevalence of parasympathetic tone. Local anesthetics can also
      modulate autonomic receptors. For these reasons, more studies are needed to investigate the
      action of regional anesthetic neuromodulation on cancer progression.[11]

      The Erector Spinae Plane Block (ESP block) is most often performed on thoracic paraspinal
      levels, causes sympathetic blockage. Sympathetic block has been studied on central neuraxial
      blocks but the sympathetic block caused by the ESP block and immune responses remain unclear.

      Sympathetic block inhibits hyperbolic immune responses after surgery, therefore enhances
      postoperative rate of acceleration on cytokine levels. The investigators propose that ESP
      block improves immune responses and improved immune responses have better clinical outcomes
      for patients with breast cancer. Improved immune responses decrease length of stay (LOS),
      enhance postoperative recovery, analgesia and quality of life. Therefore allows better
      patient experience about procedures.

      The investigators will take 90 patients who will undergo a breast cancer operation and
      compare vitals (heart rate, blood pressure, oxygen saturation), Numeric Rating Scales (NRS),
      Vascular Endothelial Growth Factor (VEGF) responses, systemic immune inflammatory indexes,
      cortisol levels, CRP and Procalcitonin levels between three groups; opioid analgesia
      group(group M), ESP block group(group E), non-opioid non-ESP group (group P).

      The investigators' main focus is immune alterations after anesthesia techniques.
      Anesthesiologist keep track of pain scores after surgery. this trials secondary outcome
      focuses on pain management after surgery.
    

Intervention name(s): Morphine; Erector Spinae Block; Control
Intervention type(s): Drug; Procedure; Drug
Intervention description(s): PREOPERATIVE ANALGESIA: None
INTRAOPERATİVE ANALGESIA:
Paracetamol 1000 mg IV
Morphine 0,1 mg/kg IV
POSTOPERATIVE ANALGESIA IV Morphine Patient-Controlled Analgesia (PCA) Rescue analgesic: IV paracetamol; PREOPERATIVE ANALGESIA:
Ultrasonography (USG) guided ESP block:T4 spinal level, %0,25 concentration 20 ml, single injection
INTRAOPERATİVE ANALGESIA:
Paracetamol 1000 mg IV
dexketoprofen 50 mg IV
POSTOPERATIVE ANALGESIA IV PCA with tramadol Rescue analgesic: IV paracetamol; PREOPERATIVE ANALGESIA: none
INTRAOPERATİVE ANALGESIA:
Paracetamol 1000 mg IV
Dexketoprofen 50 mg IV
POSTOPERATIVE ANALGESIA IV PCA with tramadol Rescue analgesic: IV paracetamol
Other intervention name(s): Opioid; Plane block; other
Intervention MeSH terms: Morphine
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        The investigators will evaluate unilateral breast cancer patients from Ankara Dr.
        Abdurrahman Yurtaslan Oncology Train and Research Hospital who will undergo Mastectomy
        procedure.

        The investigators will exclude patients who no longer want to participate at any part of
        the trial.

        A total of 90 patients' data will be collected.
      
Biospecimen description: 
      blood sample
    
Keywords: erector spinae plane block; breast cancer; anesthesia and cancer; nerve block and cancer; cancer prognosis