Commentary on: Breast Augmentation and Augmentation-Mastopexy With Local Anesthesia and Intravenous Sedation

Abstract

In their article “Breast Augmentation and Augmentation-Mastopexy With Local Anesthesia and Intravenous Sedation,” Drs. Colque and Eisemann have provided us with a retrospective review of 171 patients who underwent bilateral breast augmentation or augmentation-mastopexy from January 1, 2007, to October 30, 2009. All these procedures were performed in a facility accredited by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). The anesthetic approach employed by the authors entails intravenous sedation with midazolam, fentanyl, and ketamine, and the procedure is directed by the operating surgeon and administered by a nurse. Intercostal nerve blocks injected into intercostal spaces 3-7 at the midaxillary line and the lateral sternal border provide a lateral and medial block to the breast tissue. The authors inject a mixture of 0.25% bupivacaine and 1% lidocaine, equally mixed, with an average dose of 79.6 mL. In the report, Drs. Colque and Eisemann emphasize that their approach differs from other techniques reported in the literature, including those that rely on propofol.1–5 AAAASF standards require an anesthesiologist or nurse anesthetist to be present when propofol is administered, but intravenous ketamine may be used at the discretion of the operating surgeon. The authors reported a decrease in the occurrence of postoperative nausea and vomiting (PONV), length of stay in the recovery room, and postoperative bleeding. They did not discuss the …