TOPLINE

Most patients undergoing breast surgery with tumescent local anesthesia (TLA) reported being satisfied or very satisfied with the procedure, with inpatients showing significantly higher satisfaction than outpatients. Postoperative complications occurred in fewer than 6% of cases, and most patients would choose TLA again and recommend it to others.

METHODOLOGY

• Researchers conducted a retrospective study of 104 patients (103 women) who underwent breast surgery using TLA between January 2022 and January 2023 at a hospital in Germany.
• Patients were divided into two groups: outpatients with benign histology and lesions with uncertain malignant potential undergoing minor procedures (n = 57, mean age 48.4 years) and inpatients with malignant diagnoses undergoing more complex surgeries (n = 47, mean age 74.1 years).
• TLA solution contained lidocaine, ropivacaine, and epinephrine; concentration (0.05% or 0.21%) was selected based on surgical extent and duration.
• Surgical procedures ranged from excisional biopsy and ductectomy to breast-conserving therapy with or without sentinel-node biopsy (SNB) and mastectomy with or without SNB.
• Patient satisfaction was assessed via a locally developed questionnaire mailed an average of 5.4 months postoperatively; other outcomes included TLA volume, need for supplementary analgosedation, and complication rates.

TAKEAWAY

• Overall, 96.1% of patients were very satisfied with the surgery, with inpatients reporting significantly higher satisfaction (P = .022). In addition, 90.4% of patients expressed willingness to undergo the surgery again under TLA, and 89.4% would recommend similar surgery using TLA to a friend.
• Postoperative complications occurred in 6 patients (5.8%), including 4 wound infections requiring oral antibiotics, 1 postoperative bleeding requiring surgery, and 1 breast abscess requiring surgical intervention, with no significant difference between groups.
• Inpatients reported significantly less postoperative pain and required analgesics less frequently and for shorter durations than outpatients (29.8% vs 64.9%; P < .001).
• Inpatients required significantly higher total infiltration volumes (473.3 mL vs 184.7 mL) and total anesthetic doses (379.2 mg vs 233.8; P < .001 for both) compared with outpatients. Overall, 24.0% of patients opted for intraoperative midazolam sedation at a mean dose of 1.5 mg, with significantly more inpatients requesting sedation than outpatients (P < .001).

IN PRACTICE

"Patients' high satisfaction and recommendation level and the low rate of complications are convincing reasons to offer TLA as an alternative to general anesthesia for a large spectrum of breast surgeries," wrote the authors of the study.

SOURCE

The study was led by M. Meffert, Department of Women's Health, University Hospital of Tuebingen, Tuebingen, Germany. It was published online on July 18 in Archives of Gynecology and Obstetrics.

LIMITATIONS

The primary endpoint was assessed using a non-validated, locally developed questionnaire, and potential non-response bias may limit generalizability. The retrospective design with a mean 5.4-month interval between surgery and survey may have introduced recall bias. The absence of a general anesthesia control group precludes direct comparative conclusions.

DISCLOSURES

Open Access funding was enabled and organized by Projekt DEAL. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.