Norepinephrine has positive effect on hemorrhage, pain, and hospitalization in MAMIR for Benign Breast Nodules: Study

Breast tumors are common among
women and range from benign to malignant. Benign tumors are non-invasive but
affect function and aesthetics, needing surgical removal. Mammotome-assisted
minimally invasive resection (MAMIR) is increasingly used for managing benign
nodules of the breast. However, the procedure involves many technicalities and
is challenging. Previous research has shown that norepinephrine may improve the
surgical effect and reduce intraoperative hemorrhage and pain caused by
surgery. Hence, Chinese researchers conducted a study to assess the efficacy of
norepinephrine application in MAMIR concerning intraoperative hemorrhage,
postoperative pain, and postoperative hospitalization.

This retrospective cohort study
included 306 patients with breast nodules admitted at the Xishan People’s
Hospital of Wuxi City between June 2021 and July 2023. Patient’s data,
including age, comorbidities like hypertension and diabetes, and
characteristics of the breast nodule (number, unilateral or bilateral nature,
inner quadrant volume, and total volume), were carefully recorded. Operation
time, intraoperative hemorrhage, postoperative hospitalization, and Visual
analog scale (VAS) score, including postoperative 6-hour pain score, were also
documented. Patients were categorized into non-NPP (norepinephrine) and NPP
groups based on the application of norepinephrine. Univariate and multivariate
analyses were performed to estimate the odds ratio (OR) and the 95% confidence
intervals (CIs) for outcomes.

Findings:

• A total of 155 individuals who accepted MAMIR
  were included in the study.
• Intraoperative bleeding, postoperative pain, and
  the duration of hospitalization were less in the NPP group (p < 0.05).
• According to the Univariable analysis,
  norepinephrine usage reduced intraoperative hemorrhage during the surgery, alleviated
  postoperative pain, and shortened hospital stay.
• Multivariate analysis revealed that
  norepinephrine usage was an independent factor during MAMIR as it was associated
  with reduced intraoperative hemorrhage and postoperative pain after adjusting
  for other factors.

Thus, the study concluded that adding
norepinephrine to assist local infiltration during preoperative local
anesthesia improved the operational details. It resulted in reduced
intraoperative hemorrhage, postoperative pain, and postoperative
hospitalization. The researchers added that the addition of norepinephrine was
safe, effective, and an independent positive predictive factor for reducing
pain and hemorrhage in MAMI for benign breast nodule surgery.

Further reading: Sun, Y., Xu, Z.,
Hu, J. et al. The efficacy of norepinephrine application in
Mammotome-assisted minimally invasive resection for benign breast neoplasm: A
retrospective study. BMC Surg 24, 393 (2024). Doi: https://doi.org/10.1186/s12893-024-02701-y