Recovering elective breast surgery during the era of COVID-19 – using regional anaesthesia to allow day case risk reducing mastectomy and immediate breast reconstruction

Abstract

Introduction: For many patients routine breast cancer surgery is low risk and can normally be delivered safely within the context of day case pathways. However, larger and more complex surgery, including breast reconstruction, has typically required a longer hospital admission or overnight stay. In the current Coronavirus Pandemic climate, many surgeries requiring admission are at risk of cancellations, due to hospital pressures or staff shortages. Furthermore, when day-case treatments are planned, a number of patients end up with unforeseen admission, often due to pain, post-operative nausea and vomiting, or prolonged sedation. As such, new methods of maximising theatre and hospital efficiency should be sought. Regional anaesthesia can help reduce negative effects of general anaesthesia and when used with the correct expertise can help facilitate day case surgery by maximising postoperative analgesia, reducing discomfort and minimising nausea. Currently, there is little evidence that evaluates the outcomes of day case implant based breast reconstruction within the risk reduction setting, and even less for the use of regional anaesthesia in this setting.
Conclusion: Clinical outcomes including anaesthetic and surgical time, time through recovery and to discharge will be gathered. Complication data will also be collected alongside psychosocial and quality of life outcome measures.