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

Abstract

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.

Enhanced Recovery After Surgery (ERAS) Pathways for Aesthetic Breast Surgery: A Prospective Cohort Study on Patient-Reported Outcomes

“…The higher doses of propofol and alfentanil typically administered in general anesthesia difficult recovery, especially in the first 48 h, and therefore are more likely to require inpatient hospitalization postoperatively. The authors have previously shown that patients after aesthetic breast surgery according to the ERAS protocol described herein are recovering sooner than expected after general surgery (drinking, eating, and voiding within a median (IQR) of 0:45 (1:19–0:25) h, discharge within a median of 2:40 (3:43–1:58) h [ 13 ].…”

“…Pain, nausea, and drowsiness are the most frequent causes for delaying discharge [ 30 ]. Evidence has been presented that opioid-sparing anesthesia improves recovery without compromising patient safety and pain control [ 13 , 25 ].…”

“…Underage patients and patients requiring revision surgeries within the first week were excluded, as were patients with incomplete self-assessment questionnaires or incomplete clinical study reports. The ERAS protocol and anesthesia was performed as previously described by the authors [ 13 ]. All patients received 1000 mg acetaminophen and 1000 mg tranexamic acid PO 2 h before surgery, as well as dexamethasone 4 mg IV before starting the surgery (Table 1 ).…”

“…The authors described preoperative counseling explicitly in previously published work [ 13 ]. Patients engaged in minimal work-related physical activity and were advised to take 7 days off work.…”

“…Items from the World Health Organization (WHO) International Classification of Functioning, Disability, and Health (ICF) were chosen based on expert opinions and literature research [ 17 , 18 ]. The development of the questionnaire has been described elsewhere [ 13 ]. Primary and secondary outcome parameters and timing of assessments were: Structured self-assessment questionnaire for demographic data (gender, age, BMI, comorbidities, medication, and ASA score) completed before the first consultation.…”