{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T08:59:27Z","timestamp":1790067567959,"version":"4.0.1"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Breast surgeries are commonly performed under general anesthesia. The aim of the study was to compare postoperative pain following modified radical mastectomy under thoracic epidural anesthesia versus general anesthesia with the use of laryngeal mask airway.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>This randomized controlled study was performed on hundred patients undergoing unilateral modified radical mastectomy. The patients were assigned into two equal groups, E and G. Group E patients received thoracic epidural anaesthesia, and group G received general anesthesia. The primary objective was to compare postoperative pain scores between the two groups. Secondary objectives included incidence of postoperative sore throat, hoarseness of voice, cough, nausea and vomiting, perioperative analgesic requirement, patient and surgeon satisfaction, duration of hospital and intensive care unit (ICU) stay, and any associated anesthesia complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Both groups were similar with respect to demographics. Postoperative pain score was significantly lower in Group E at all time points. The perioperative analgesic requirement was significantly higher in Group G than in Group E, and this was statistically significant with\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001. Duration of hospital stay and intraoperative hemodynamics were comparable between the two groups. Patient satisfaction was significantly higher in Group G; however, surgeons were satisfied with both methods. Sore throat, cough, hoarseness of voice, nausea and vomiting, and duration of ICU stay were significantly higher in group G. Infiltration of local anesthetic in the axilla was required in 10% of the patients in the epidural group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Although patients found general anesthesia more satisfying, thoracic epidural anesthesia provided significantly better postoperative analgesia compared with general anesthesia with laryngeal mask airway inpatients undergoing modified radical mastectomy and was associated with significantly lower ICU stay, comparable surgeon satisfaction with lower incidence of postoperative sore throat, nausea and vomiting, hoarseness of voice, and cough.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/aam.aam_441_25","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T15:00:23Z","timestamp":1764082823000},"page":"1694-1698","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Postoperative Pain Following Modified Radical Mastectomy under Thoracic Epidural Anesthesia versus General Anesthesia: A Randomized Control Trial"],"prefix":"10.4103","volume":"25","author":[{"given":"Nitu","family":"Puthenveettil","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sundeep","family":"Vijayaraghavan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil","family":"Rajan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"key":"R1-20260922","doi-asserted-by":"crossref","first-page":"e640","DOI":"10.1097\/PR9.0000000000000640","article-title":"Postoperative opioids, endocrine changes, and immunosuppression","volume":"3","author":"Haroutounian","year":"2018","journal-title":"Pain Rep"},{"key":"R2-20260922","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/s42077-022-00281-8","article-title":"Comparison between thoracic paravertebral block and segmental thoracic spinal anaesthesia in breast cancer surgery","volume":"14","author":"Mazy","year":"2022","journal-title":"Ain Shams J Anesthesiol"},{"key":"R3-20260922","doi-asserted-by":"crossref","first-page":"592","DOI":"10.18231\/j.ijca.2019.115","article-title":"A prospective study to compare the quality of analgesia after breast cancer surgery using pectoral nerve block versus thoracic paravertebral block","volume":"6","author":"Meena","year":"2019","journal-title":"Indian J clin Anaesth"},{"key":"R4-20260922","first-page":"e51103","article-title":"A randomized clinical study to compare the perioperative analgesic efficacy of ultrasound-guided erector spinae plane block over thoracic epidural in modified radical mastectomy","volume":"15","author":"Deepshika","year":"2023","journal-title":"Cureus"},{"key":"R5-20260922","doi-asserted-by":"crossref","first-page":"191","DOI":"10.4097\/kja.20679","article-title":"Anesthetics or anesthetic techniques and cancer surgical outcomes: A possible link","volume":"74","author":"Alam","year":"2021","journal-title":"Korean J Anesthesiol"},{"issue":"Suppl 1","key":"R6-20260922","doi-asserted-by":"crossref","first-page":"i17","DOI":"10.1093\/bja\/aes421","article-title":"Can anaesthetic and analgesic techniques affect cancer recurrence or metastasis?","volume":"109","author":"Heaney","year":"2012","journal-title":"Br J Anaesth"},{"key":"R7-20260922","doi-asserted-by":"crossref","first-page":"316","DOI":"10.18231\/j.ijca.2021.058","article-title":"The efficacy of thoracic epidural anaesthesia for breast surgeries","volume":"8","author":"Vishwanath","year":"2021","journal-title":"Indian J Clin Anaesth"},{"key":"R8-20260922","doi-asserted-by":"crossref","first-page":"AN09","DOI":"10.21276\/aimdr.2017.3.3.AN2","article-title":"A prospective observational study to assess the efficacy of thoracic epidural anaesthesia for mastectomy","volume":"3","author":"Vineetha","year":"2017","journal-title":"Ann Int Med Dent Res"},{"key":"R9-20260922","first-page":"13","article-title":"Comparitive study between thoracic epidural and general anaesthesia for modified radical mastectomy","volume":"4","author":"Bhardwaj","year":"2017","journal-title":"Indian J Clin Anaesth"},{"key":"R10-20260922","doi-asserted-by":"crossref","first-page":"111","DOI":"10.18585\/inabj.v7i2.77","article-title":"A comparative study between thoracic epidural anaesthesia and general anaesthesia for patients who underwent modiied radical mastectomy with axillary lymph node dissection in de la Salle university medical center","volume":"7","author":"Oktavia","year":"2015","journal-title":"Indones Biomed J"},{"key":"R11-20260922","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1023\/A:1011448927817","article-title":"Effects of high thoracic epidural anesthesia and local anesthetics on bronchial hyperreactivity","volume":"16","author":"Groeben","year":"2000","journal-title":"J Clin Monit Comput"},{"key":"R12-20260922","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.bjan.2012.08.001","article-title":"Prospective, randomized clinical trial of laryngeal mask airway Supreme(\u00ae) used in patients undergoing general anaesthesia","volume":"63","author":"Barreira","year":"2013","journal-title":"Braz J Anesthesiol"},{"key":"R13-20260922","doi-asserted-by":"crossref","first-page":"e42","DOI":"10.1097\/YCT.0b013e3181ff2e47","article-title":"Prolonged succinylcholine action during electroconvulsive therapy (ECT) after cytarabine, vincristine, and rituximab chemotherapy","volume":"27","author":"Bryson","year":"2011","journal-title":"J ECT"},{"key":"R14-20260922","first-page":"154","article-title":"Variability in the effect of muscle relaxants. Factors involved in the pharmacodynamic profile of neuromuscular blocking agents","volume":"3","author":"Booij","year":"2009","journal-title":"Anestezjol I Ratow"},{"key":"R15-20260922","doi-asserted-by":"crossref","first-page":"21","DOI":"10.4103\/0973-1482.39601","article-title":"Prognostic and diagnostic value of serum pseudocholinesterase, serum aspartate transaminase, and serum alinine transaminase in malignancies treated by radiotherapy","volume":"4","author":"Chougule","year":"2008","journal-title":"J Cancer Res Ther"},{"key":"R16-20260922","doi-asserted-by":"crossref","first-page":"409","DOI":"10.18231\/j.ijca.2020.075","article-title":"Comparison between bupivacaine and ropivacaine in thoracic epidural anaesthesia for modified radical mastectomy \u2013 A randomized controlled trial","volume":"7","author":"Aswini","year":"2020","journal-title":"Indian J Clin Anaesth"}],"container-title":["Annals of African Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_441_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T08:00:52Z","timestamp":1790064052000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_441_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,27]]},"references-count":16,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aam.aam_441_25","relation":{},"ISSN":["1596-3519","0975-5764"],"issn-type":[{"value":"1596-3519","type":"print"},{"value":"0975-5764","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,27]]},"assertion":[{"value":"2025-08-20","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-06","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}