LEWISBURG — Evangelical Community Hospital’s John F. Turner, MD, FACS, instrumental in the founding the Thyra M. Humphreys Center for Breast Health, said his eyes were opened when he learned of a new recovery protocol for breast surgery patients.
Turner said it began while teaching at a national meeting of the American Society of Breast Surgeons. A colleague suggested attending a morning course which covered procedures done before mastectomy to reduce post-operative pain and aid in recovery.
PECs I and PECs II blocks, injections of quick onset and longer acting local anesthesia, were the topic of that meeting. Turner explained they were applied pre-op between the first and second pectoral muscles followed by a second injection toward a muscle along the chest. He said the procedure blocked the sensory thoracic nerves, reducing pain and thus the need for as much pain management after surgery.
“I’d read about giving long-acting neuromuscular blocks prior to mastectomy,” Turner said. “Sometimes you get a little skeptical about literature, people kind of exaggerate things.”
But the data they presented at the meeting was solid, Turner said, and the technique was easier than expected. He conferred with a staff anesthesiologist and Dr. Christian Kauffman, Geisinger Health Systems plastic surgeon, before proceeding with the technique locally.
“My skepticism before I went to the course was how good a block are you going to achieve by just injecting into the (muscular) plane and hoping it goes there,” Turner said. “So we tried it (and) along with that developed a protocol which involved some pre-operative medications.”
The medications worked to further control pain in advance of surgery.
Turner conceded some of the substances were expensive, but believed they were less expensive than poor outcomes from surgery or addiction to narcotic painkillers like Oxycontin. Milder narcotic substances were offered to patients. But as it turned out they were usually used only for brief periods and some patients have declined even mild pain killer use beyond the minimum.
“The earlier a patient gets back to normal motion and normal function, the better their recovery is going to be,” Turner said.
He concluded any way to reduce surgical injury was beneficial, especially if range of motion in the shoulder can be increased. Shoulder disfunction was among the more difficult issues for patients after surgery.
“It’s been one of the most amazing things in my career as far as surgical advances go,” Turner concluded. “The thing I keep thinking of is that I almost didn’t go to that course. It really was a friend that was teaching (a) course with me who said I really should go.”
Kathy Lahr of Montandon was among the first patients to benefit from the recovery protocol at Evangelical. After a series of mammograms and diagnostic procedures, a decision was made for a lumpectomy followed by radiation.
Lahr said additional cancer was found in the process and she underwent a bilateral mastectomy as a precaution.
“I really was not nervous ever,” said Lahr as she recalled her patient experience. “Dr. Turner and his staff were excellent with explanations. Everyone was calm and straightforward and I felt that way as well.”
Lahr underwent the procedure and came through it well, with positive outcomes continuing into recovery.
“I had an overnight stay and went home the next day,” she said. “I took one pain pill that night because they told me to.”
Lahr said the effect of the neuromuscular block was noticeable.
“You could tell that block lasted quite a while,” she recalled. “I had no discomfort.”
Lahr said one arm was moving freely right after surgery while the other took a little more work. She knew to not lift beyond a set weight limit.
Bernie Lahr, Kathy’s husband, was trained to help out after her surgery. He also took a photo of Kathy and sent it to friends and family in Georgia where they had lived before returning to Central Pennsylvania.
“They couldn’t believe I had just had surgery and that was my next day home,” she said. “I felt good. I wanted to be up and I wanted to be out with (Bernie) and our son.”
Bernie added that at no time was there pressure to choose one treatment option or another. He appreciated that the Evangelical staff, including their patient navigator, was totally dedicated to their case.
Call 570-522-4200 or visit www.evanhospital.com for more information about the Thyra M. Humphreys Center for Breast Health.