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Analysis of anaesthetic techniques in a breast surgery service to identify potential barriers to day case mastectomy

Robin Williams, Rebekah Wallace, Craig Urquart
Queen Elizabeth University Hospital, Glasgow, United Kingdom


Introduction: The British Association of Day Surgery benchmark rate for same-day discharge after mastectomy is 75%. Gartnavel General Hospital achieved a rate of 7.5% over the period 09/22 to 02/23. We looked for factors pertaining to anaesthetic technique (in particular, use of chest wall regional anaesthesia) which were predictive of same day discharge or associated outcomes.

Methods: Retrospective analysis of the anaesthetic techniques used for mastectomies at our institution (80 cases). Data points gathered: American Society of Anaesthesiologists physical status; total intravenous anaesthesia; intraoperative opiate; regional anaesthetic technique; peak pain score in recovery; requirement for rescue analgesia; day of discharge.

Results: More same day discharges were seen in the group which did not receive regional anaesthesia (5 of 47) than in that which did (1 of 33). The mean peak pain score in patients who received chest wall blocks (2.59) and those who did not (2.6) was similar. Of the 74 patients who were not discharged same day, 70 were discharged on day 1. The choice of opioid varied with use of block. The mean dose of morphine was 7.8mg without block and 0.6mg with; fentanyl use increased from average 76mcg without block to 169 mcg.

Conclusion: Regional anaesthetic techniques did not result in reduced pain scores after mastectomy or increased incidence of same day discharge. It did result in a significant reduction in Morphine utilisation. Surgical preference and organisational inertia may be more important barriers at this institution and we are working on an Enhanced Recovery After Surgery protocol.