The Role of Regional Anaesthesia in Improving Day Case Rates for Patients Undergoing Mastectomy
Association of Breast Surgery ePoster Library. Milligan R. 05/15/17; 166315; P174
Mr. Robert Milligan
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Abstract
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Introduction
Regional anaesthesia has been shown to improve rates of perioperative analgesia, reduced chronic pain and improved quality of life following major breast surgery.
The British Association of Day Surgery (BADS) recommends that 15% of mastectomies should be performed as day case and 70% with a single night stay in hospital. Two years ago, we commenced a quality improvement project to improve the quality, experience and throughput of patients undergoing breast cancer surgery.
Methods
Perioperative care was standardised among regular anaesthetists with an interest in breast surgery. Patients were treated with multimodal analgesia with the avoidance of long acting opioids. Regional anaesthesia was routinely used in the form of paravertebral block at the level of the third thoracic vertebra or interpleural block using loss of resistance technique.
Patients undergoing simple mastectomy (excluding reconstruction or axillary clearance) between April 2013 and October 2015 were identified from our electronic record system. Length of stay (LOS) was compared to the BADS targets. Data were analysed using Chi-square test.
Results
203 simple mastectomies were performed in the 30-month period of the audit. Our day case rate for patients undergoing mastectomy increased year-on-year from 1.5% in 2013/14 to 27.8% in 2015/16 (p=0.001). Our current practice exceeds BADS targets for day surgery mastectomy, but we have more patients staying for over 24 hours than recommended (33%vs10%). No complications of regional anaesthetic technique were reported.
Conclusions
Paravertebral and interpleural blocks may be used as part of a quality improvement programme to decrease LOS following simple mastectomy.
Regional anaesthesia has been shown to improve rates of perioperative analgesia, reduced chronic pain and improved quality of life following major breast surgery.
The British Association of Day Surgery (BADS) recommends that 15% of mastectomies should be performed as day case and 70% with a single night stay in hospital. Two years ago, we commenced a quality improvement project to improve the quality, experience and throughput of patients undergoing breast cancer surgery.
Methods
Perioperative care was standardised among regular anaesthetists with an interest in breast surgery. Patients were treated with multimodal analgesia with the avoidance of long acting opioids. Regional anaesthesia was routinely used in the form of paravertebral block at the level of the third thoracic vertebra or interpleural block using loss of resistance technique.
Patients undergoing simple mastectomy (excluding reconstruction or axillary clearance) between April 2013 and October 2015 were identified from our electronic record system. Length of stay (LOS) was compared to the BADS targets. Data were analysed using Chi-square test.
Results
203 simple mastectomies were performed in the 30-month period of the audit. Our day case rate for patients undergoing mastectomy increased year-on-year from 1.5% in 2013/14 to 27.8% in 2015/16 (p=0.001). Our current practice exceeds BADS targets for day surgery mastectomy, but we have more patients staying for over 24 hours than recommended (33%vs10%). No complications of regional anaesthetic technique were reported.
Conclusions
Paravertebral and interpleural blocks may be used as part of a quality improvement programme to decrease LOS following simple mastectomy.
Introduction
Regional anaesthesia has been shown to improve rates of perioperative analgesia, reduced chronic pain and improved quality of life following major breast surgery.
The British Association of Day Surgery (BADS) recommends that 15% of mastectomies should be performed as day case and 70% with a single night stay in hospital. Two years ago, we commenced a quality improvement project to improve the quality, experience and throughput of patients undergoing breast cancer surgery.
Methods
Perioperative care was standardised among regular anaesthetists with an interest in breast surgery. Patients were treated with multimodal analgesia with the avoidance of long acting opioids. Regional anaesthesia was routinely used in the form of paravertebral block at the level of the third thoracic vertebra or interpleural block using loss of resistance technique.
Patients undergoing simple mastectomy (excluding reconstruction or axillary clearance) between April 2013 and October 2015 were identified from our electronic record system. Length of stay (LOS) was compared to the BADS targets. Data were analysed using Chi-square test.
Results
203 simple mastectomies were performed in the 30-month period of the audit. Our day case rate for patients undergoing mastectomy increased year-on-year from 1.5% in 2013/14 to 27.8% in 2015/16 (p=0.001). Our current practice exceeds BADS targets for day surgery mastectomy, but we have more patients staying for over 24 hours than recommended (33%vs10%). No complications of regional anaesthetic technique were reported.
Conclusions
Paravertebral and interpleural blocks may be used as part of a quality improvement programme to decrease LOS following simple mastectomy.
Regional anaesthesia has been shown to improve rates of perioperative analgesia, reduced chronic pain and improved quality of life following major breast surgery.
The British Association of Day Surgery (BADS) recommends that 15% of mastectomies should be performed as day case and 70% with a single night stay in hospital. Two years ago, we commenced a quality improvement project to improve the quality, experience and throughput of patients undergoing breast cancer surgery.
Methods
Perioperative care was standardised among regular anaesthetists with an interest in breast surgery. Patients were treated with multimodal analgesia with the avoidance of long acting opioids. Regional anaesthesia was routinely used in the form of paravertebral block at the level of the third thoracic vertebra or interpleural block using loss of resistance technique.
Patients undergoing simple mastectomy (excluding reconstruction or axillary clearance) between April 2013 and October 2015 were identified from our electronic record system. Length of stay (LOS) was compared to the BADS targets. Data were analysed using Chi-square test.
Results
203 simple mastectomies were performed in the 30-month period of the audit. Our day case rate for patients undergoing mastectomy increased year-on-year from 1.5% in 2013/14 to 27.8% in 2015/16 (p=0.001). Our current practice exceeds BADS targets for day surgery mastectomy, but we have more patients staying for over 24 hours than recommended (33%vs10%). No complications of regional anaesthetic technique were reported.
Conclusions
Paravertebral and interpleural blocks may be used as part of a quality improvement programme to decrease LOS following simple mastectomy.
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