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Is TIVA the superior choice of anaesthesia for day-case breast patients undergoing oncoplastic breast surgery?

Chantae Reid-Agboola1,2, Helen Fenner1, Georgette Oni1,2
1Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom. 2School of Medicine, University of Nottingham, Nottingham, United Kingdom


Introduction: The ability to perform oncoplastic breast procedures (OPBS) as day-cases could improve patient flow and reduce waiting lists. Factors preventing same day discharge include poor pain control and postoperative nausea and vomiting (PONV). Limited data exists comparing different anaesthesia used in day-case oncoplastic breast surgery and the immediate post operative period, this study aims to look at this relationship.

Method: We undertook a retrospective analysis of all OPBS conducted at our day-case facility over 12 months. Type of anaesthetic was categorised as total intravenous anaesthesia (TIVA) or vapour with sevofluorane (SEVO). Other data collected included post-operative recovery time, post-operative nausea data and opioid analgesia before discharge.

Results: 103 cases identified over 12 months identified (79.6% were bilateral). 56.3% (N=58) TIVA (51 with remifentanil, 7 with alfentanil) and 43.7% (N=45) SEVO. On average TIVA had less morphine requirements post operatively (20.2mg vs 33.2mg, p<0.0001) and shorter times to discharge (205.9mins vs 229.6mins p=0.027). 48.3% of TIVA cases had PONV (6 out of 7 with alfentanil) vs 55.6% SEVO but this was not significantly related to morphine given post operatively (p=0.281). 99% were discharged same day (1 admitted for pain control).

Conclusion: This study shows that OPBS can be performed as day-case procedures. TIVA appears to be associated with less PONV, less morphine requirements for post-operative pain control and a shorter discharge time. The differences between remifentanil and alfentanil warrant further investigation. Adopting a TIVA day-case protocol could be beneficial for patient recovery/discharge as well as waiting lists/operative capacity.