IMPACT OF ANESTHETIC TECHNIQUE ON LENGTH OF PERIOPERATIVE PHASES OF CARE IN LUMPECTOMY COMBINED WITH SENTINEL LYMPH NODE BIOPSY

Objectives:

Introduction: Lumpectomy combined with sentinel lymph node biopsy (SLNB) is a common procedure for patients with invasive breast cancer. The anesthetic technique used for these procedures is not standardized.

Methods:

Methods: We performed a retrospective review to describe the use of anesthetic techniques employed by our group in patients who underwent lumpectomy + SLNB in 2019 and to explore the impact of anesthetic technique on the length of the perioperative phases of care. The anesthetic techniques were: 1. intravenous combined with local anesthetic (IV + Local) 2. Intravenous combined with local and use of laryngeal mask (IV + Local, LMA) 3. General Endotracheal (GET).

Results:

Results: Two hundred eighteen patients underwent lumpectomy + SLNB in 2019. Fifty-eight patients had IV + Local, seventy-six patients had IV + local, LMA and eighty-four patients had GET. Patients who had GET had a higher body mass index (p = 0.011). The time to complete the operative procedure varied according to surgeon. Patients who underwent GET had a longer stay in the post-operative care unit (PACU) (p = 0.016). In a multivariate analysis the following variables were associated with a prolonged PACU time: delivery of paralytic drugs (OR 2.46, p = 0.008), increasing number of sentinel lymph nodes removed (OR 2.46, p = 0.007), use of ketamine (OR 5.77, p = < 0.001), need for antiemetic drug in PACU (OR 5.29, p = 0.003). The use of IV + Local was not associated with an increase in the likelihood of returning to the operating room within six weeks, decreased number of sentinel lymph nodes removed or higher rate of positive margins after lumpectomy.

Conclusion:

Conclusions: In patients undergoing lumpectomy + SLNB, anesthetic techniques varied. In univariate analysis, the use of general endotracheal anesthesia was associated with a prolonged stay in the PACU. In multivariate analysis, the use of paralytics, antiemetics, or ketamine was associated with a prolonged stay in the PACU. Removing a greater number of sentinel nodes was associated a prolonged stay in the PACU. The use of IV + local or IV + local, LMA did not appear to negatively impact the number of sentinel nodes removed or the need for return to the operating room. Performing lumpectomy + SLNB under local anesthesia with intravenous sedation appears to be feasible and safe but not clearly associated with shorter PACU stays. Our future investigations will explore the impact of anesthetic technique on patient-centered outcomes and perioperative costs.