Experience of Immediate Ambulation and Early Discharge After Tumescent Anesthesia and Propofol Infusion in Cosmetic Breast Augmentation

Pang, Wei‐Wu; Chois, John M.; Lambie, Diana; Lin, Richard; Shih, Zao-Ming

doi:10.1007/s00266-017-0929-5

Cited by 10 publications

(6 citation statements)

References 25 publications

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“…The propofol dosage of 4.89 (5.48–4.26) mg/kg/h compares well with previous studies using higher concentrations of ropivacaine or lidocaine for breast augmentation under sedation [ 26 , 27 ]. Sedation provides general patient comfort and some amnesia for both the block procedure and the surgical procedure [ 28 ].…”

Section: Discussionsupporting

confidence: 80%

Enhanced Recovery After Aesthetic Breast Surgery Under Sedation, Intercostal Block and Tumescent Anaesthesia: A Prospective Cohort Study of the Early Postoperative Phase

Stahl¹,

Stahl²,

Feng

et al. 2022

Aesth Plast Surg

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Background Comfort and recovery are major concerns of patients seeking aesthetic surgery. This study aimed to assess postoperative pain and recovery after outpatient breast surgery under sedation, intercostal block, and local anaesthesia. Methods This prospective cohort study included all consecutive patients who underwent aesthetic breast surgery between April 2021 and August 2022. Epidemiological data, anaesthesia, pain, and patients’ satisfaction were systematically assessed with standardized self-assessment questionnaires. Results Altogether, 48 patients [median (IQR) age: 30 (36–25)] were included. The most frequent surgery was mastopexy. 69% of surgeries involved additional procedures. The mean intercostal block and local anaesthesia time was 15 min. Patients received a median (IQR) of 19 (34–2) mg/kg lidocaine and 2.3 (2.5–2.0) mg/kg ropivacaine. The median (IQR) consumption of propofol and alfentanil was, respectively, 4.89 (5.48–4.26) mg/kg/h and 0.27 (0.39–0.19) µg/kg/min. No conversion to general anaesthesia or unplanned hospital admission occurred. Patients were discharged after a median (IQR) of 2:40 (3:43–1:58) hours. Within the first 24 postoperative hours, 17% required once an antiemetic medication and 38% an opioid. Patients were very satisfied with the anaesthesia and 90% of the patients had not wished more analgesia in the first 24 h. Conclusions Aesthetic breast surgery under sedation, intercostal block, and tumescent anaesthesia can safely be performed as an ambulatory procedure and is associated with minimal intra- and postoperative opioid consumption and high patient satisfaction. These data may be used to inform patients and clinicians and improve the overall quality of care. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Supplementary Information The online version contains supplementary material available at 10.1007/s00266-022-03214-w.

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Section: Discussionsupporting

confidence: 80%

Enhanced Recovery After Aesthetic Breast Surgery Under Sedation, Intercostal Block and Tumescent Anaesthesia: A Prospective Cohort Study of the Early Postoperative Phase

Stahl¹,

Stahl²,

Feng

et al. 2022

Aesth Plast Surg

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“…9 Several methods including multimodal analgesia and local anesthetic infiltration have been reported to reduce pain and/or opioid use after breast augmentation. 10,11 However, pain control is not always adequately achieved and may cause unwanted side effects. 12 Recently, the pectoral nerves blocks (PECtoral nerveS blocks I and II [PECS I and PECS II]) were proposed for analgesia during and after breast surgery.…”

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Pectoral Nerve Blocks for Breast Augmentation Surgery: A Randomized, Double-blind, Dual-centered Controlled Trial

et al. 2021

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Background Pectoral nerve blocks have been proposed for analgesia during and after breast cancer surgery, but data are conflicted in aesthetic breast surgery. This trial tested the primary hypothesis that adding a preincisional pectoral nerve block is superior to systemic multimodal analgesic regimen alone for pain control after breast augmentation surgery. A second hypothesis is that rescue opioid consumption would be decreased with a long-lasting effect for both outcomes during the following days. Methods Seventy-three adult female patients undergoing aesthetic breast augmentation surgery under general anesthesia were randomly allocated to receive a pectoral nerve block versus no block. Both groups received standard care with protocolized multimodal analgesia alone including systematic acetaminophen and nonsteroidal anti-inflammatory drugs. The primary outcome measure was the maximal numerical rating scale in the first 6 h after extubation. Secondary outcomes included intraoperative remifentanil consumption and from extubation to day 5: maximal numerical rating scale, postoperative cumulative opioid consumption and postoperative opioid side effects, and patient satisfaction recorded at day 5. Results The maximal numerical rating scale score in the first 6 h was lower in the pectoral nerve block group compared with the control group (3.9 ± 2.5 vs. 5.2 ± 2.2; difference: –1.2 [95% CI, –2.3 to –0.1]; P = 0.036). The pectoral nerve block group had a lower maximal numerical rating scale between days 1 and 5 (2.2 ± 1.9 vs. 3.2 ± 1.7; P = 0.032). The cumulative amount of overall opioids consumption (oral morphine equivalent) was lower for the pectoral nerve block group from hour 6 to day 1 (0.0 [0.0 to 21.0] vs. 21.0 [0.0 to 31.5] mg, P = 0.006) and from days 1 to 5 (0.0 [0.0 to 21.0] vs. 21.0 [0.0 to 51] mg, P = 0.002). Conclusions Pectoral nerve block in conjunction with multimodal analgesia provides effective perioperative pain relief after aesthetic breast surgery and is associated with reduced opioid consumption over the first 5 postoperative days. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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“…Procedures including, but not limited to, liposuction, abdominoplasties, facelifts, and rhinoplasties have techniques inclusive of tumescence [1]. The effect of intraoperative tumescence use, and its analgesia has allowed for decreased post operative pain, increased ambulation, and higher patient satisfaction scores [2]. As techniques evolve to accommodate large volume liposuction, lower levels of lidocaine has proven efficacious to reduce the chance of lidocaine toxicity without affecting surgical result [3].…”

Section: Effects Of Tumescent Anesthesia On Recoverymentioning

confidence: 99%

Current Standards of Liposuction Surgery and the Effect of Tumescent Anesthesia on Patient Recovery

Clive¹,

Joseph²

2022

J Cosmet Surg

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Experience of Immediate Ambulation and Early Discharge After Tumescent Anesthesia and Propofol Infusion in Cosmetic Breast Augmentation

Abstract: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cited by 10 publications

References 25 publications

Enhanced Recovery After Aesthetic Breast Surgery Under Sedation, Intercostal Block and Tumescent Anaesthesia: A Prospective Cohort Study of the Early Postoperative Phase

Enhanced Recovery After Aesthetic Breast Surgery Under Sedation, Intercostal Block and Tumescent Anaesthesia: A Prospective Cohort Study of the Early Postoperative Phase

Pectoral Nerve Blocks for Breast Augmentation Surgery: A Randomized, Double-blind, Dual-centered Controlled Trial

Current Standards of Liposuction Surgery and the Effect of Tumescent Anesthesia on Patient Recovery

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