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