Impact of Loco-regional Anaesthetic Techniques Versus General Anaesthesia in Women Aged ≥ 65 Undergoing Primary Breast Cancer Surgery: A Systematic Review of the Literature

INTRODUCTION: Women aged ≥ 65 with multiple comorbidities are at increased risk of perioperative complications, loco-regional anaesthetic techniques (LRA) may reduce perioperative complications compared to general anaesthesia (GA); however, evidence specific to patients aged ≥ 65 is limited. METHODS: A systematic search was conducted using Cochrane, Embase, MEDLINE and Web of Science from database inception to 7 April 2025. Studies comparing LRA to GA, with any number of women aged ≥ 65 undergoing primary breast cancer surgeries, were included. RESULTS: Eight studies with a total of 255,088 women, of whom 55,310 were aged ≥ 65, were included. Four studies were prospective and four were retrospective. 192,453 women received GA. Four studies compared local anaesthesia alone (number of women aged ≥ 65, n = 54,852) to GA, and one study each compared local + regional anaesthesia (n ≥ 65 = 389), pectoral nerve blocks (n ≥ 65 = 42), paravertebral block (n ≥ 65 = 26) and thoracic epidural (n ≥ 65 = 1) to GA. Overall, LRA techniques had lower rates of post-operative nausea and vomiting, confusion and operative duration. CONCLUSIONS: LRA may have a role in patients who are unfit for or cannot undergo GA for breast cancer surgery; however, data specific to women ≥ 65 years are sparse and there are many confounding factors which impact usability of LRA techniques, for example type of breast and axillary surgery and availability of technique.