Regional Block Anesthesia Research Articles

Standing oral surgery for the management of mandible and maxilla fractures in horses: a case series of 15 horses

Fractures of the mandible and maxilla are common in horses. The present study was conducted on fifteen horses referred for the management of mandible or maxilla fractures. Fixation methods were used to repair the fractures in these horses, including tension band and cerclage wires, dynamic compression plates, and lag screw fixation. All procedures were performed under chemical restraint and regional nerve block anesthesia in the standing position. According to the results, the long term follow-up of the horses was satisfactory, and no severe complications were observed. Jaw fractures are most successfully treated by early diagnosis and fracture fixation. The surgical management of most oral region injuries may be readily performed in the standing position, to avoid the risks associated with general anesthesia in horses.

Utility of Erector Spinae Plane Blocks for Postoperative Pain Management and Opioid Reduction Following Lumbar Fusions.

Retrospective. The purpose of this study was to determine the utility of the erector spinae plane regional anesthesia (ESP) block in reducing opioid medication usage and postanesthesia care unit length of stay (PACU-LOS) for patients undergoing either a posterior or transforaminal lumbar interbody fusions (PLIF/TLIF). Posterior lumbar spine fusion is a common surgical procedure typically associated with significant postoperative pain. Poorly controlled postoperative pain can lead to a number of poor outcomes. Although opioids are a mainstay for pain control, they are associated with adverse effects and a risk of dependence. Therefore, multimodal pain control has become more prevalent in orthopedics and combines traditional opioid and nonopioid pain mediation with general anesthesia protocols and regional nerve blocks. A retrospective chart review was conducted for patients undergoing PLIFs or TLIFs between 2019 and 2021. Patients were placed into 2 groups, those receiving an ESP block and those that did not. T tests assuming unequal variances were used to assess differences in pain scores, opioid consumption, and PACU-LOS between groups. The study group demonstrated a 35% reduction in opioid use ( P =0.016), a 16% reduction in pain with activity ( P =0.042), and a 9.7% reduction in pain at rest ( P =0.219) compared with the control group. There were no significant differences in PACU-LOS between groups ( P =0.314). The use of an ESP block for patients undergoing PLIFs and TLIFs appears to be a safe and effective means to manage postoperative pain and reduce opioid consumption.

Expert consensus on analgesia for image-guided thermal ablation of tumors

Image-guided thermal ablation (IGTA) has been applied in the treatment of tumors, and the number of patients treated is increasing rapidly every year. The Ablation Expert Committee of the Chinese Society of Clinical Oncology, the Society of Tumor Ablation Therapy of the Chinese Anti-Cancer Association,the Tumor Ablation Committee of the Chinese College of Interventionalists, and the Expert Group on Tumor Ablation Therapy of the Chinese Medical Doctors provided the platform for multidisciplinary experts to formulate the "Expert consensus on analgesia for image-guided tumor thermal ablation (2022 Edition)". The main contents of the"Expert consensus"include: (1) preparation of medicines and equipment; (2) Multimodal analgesia, local anesthesia, regional nerve block or spinal anesthesia combined with analgesic sedation, general anesthesia; (3) common adverse reactions and management of perioperative anesthesia.

Supplemental Regional Anesthetic Block Reduces Opioid Utilization Following Free Flap Reconstruction of the Oral Cavity - A Single-Institution Randomized Controlled Trial

Supplemental Regional Anesthetic Block Reduces Opioid Utilization Following Free Flap Reconstruction of the Oral Cavity - A Single-Institution Randomized Controlled Trial

424 High Volume vs. Low Volume Transversus Abdominis Plane (TAP) Blocks and Post-Operative Pain in Elective Colorectal Surgery- the More the Merrier?

Abstract Introduction Transversus abdominis plane (TAP) regional anaesthetic blocks are often performed by surgeons and provide effective anaglesia in the immediate postoperative period. It is not known whether the volume and concentration of local anaesthetic used for TAP blocks influences the quality of analgesia when the total drug dose is similar. Aim This pilot aimed to compare low volume versus high-volume TAP block and post-operative pain in patients undergoing elective colorectal surgery, using analgesic consumption as a proxy for pain. Method Single centre cohort study. Data were collected for patients undergoing elective colorectal resections from April – December 2021. Patients were cohorted into those receiving low-volume, high-concentration TAP block (40–50ml 0.25% levobupivacaine) and those receiving high-volume, low-concentration TAP block (100ml 0.125% levobupivacaine). Data including PCA (patient-controlled analgesia) type (morphine/ oxycodone) and post-operative consumption were collected. Results 107 patients undergoing elective colorectal resections were identified. Data regarding TAP block usage was available for 55 patients. 23 (41.8%) patients were given high volume TAP blocks. 78.3% (p=0.56) of patients in the high-volume group were prescribed a PCA postoperatively, compared to 84.3% in the low-volume group. Median morphine PCA consumption was 11mg in the high-volume cohort, compared to 18mg in the low volume cohort (p=0.23). Conclusions High volume TAP block was associated with reduced requirement for a post-operative PCA and a reduced consumption of morphine PCA. Although not statistically significant in our small sample size, our results may be of interest to surgeons and suggest that the use of high-volume TAP blocks warrants further study.

Implementation of a chest injury pathway in the emergency department

Rib fractures represent a substantial health burden. Chest injuries contribute to 25% of deaths after trauma and survivors can experience long-standing consequences, such as reduced functional capabilities and loss of...

Periosteal block versus intravenous regional anesthesia for reduction of distal radius fractures: A randomized controlled trial.

We compare periosteal block and intravenous regional anesthesia (IVRA) as anesthetic techniques for reduction of distal radius fractures when performed by emergency department (ED) clinicians following brief training. This was a single-center, nonblinded randomized controlled trial of a convenience sample of patients presenting with distal radius fractures requiring closed reduction. Primary outcome measure was patient reported fracture reduction pain score, rated on a 100-mm visual analog scale. Secondary outcomes included adjunct pain medication use, ED length of stay, remanipulation rates, participant satisfaction, clinician assessed efficacy, and clinician-assessed ease of the procedure. Eighty-one patients were randomized to receive IVRA (n= 41) or periosteal block (N= 40). Reduction pain scores were not normally distributed. Median (25th-75th percentile) pain scores in participants assigned to IVRA and periosteal block were 5 (1-27.5) and 26 (8.5-63)mm, respectively, (p= 0.007). Use of adjunct medications during reduction was higher for the periosteal block group compared with IVRA (57.5% vs. 22.5%, p= 0.003). Remanipulation rates were 17.5% for periosteal block versus 7.5% for IVRA (p= 0.31). There was no difference in length of stay, patient satisfaction, or clinician's assessed ease of the anesthetic technique. There was a difference in clinician's assessment of efficacy between groups, with IVRA described as "extremely effective" by 65% and periosteal block described as "extremely effective" by 25% (p= 0.003). When performed by a diverse group of ED clinicians periosteal block provided inferior analgesia to IVRA but may provide an alternative when IVRA cannot be performed.

Preoperative transversus abdominis plane block decreases intraoperative opiate consumption during minimally invasive cholecystectomy.

The ongoing epidemic of prescription opiate abuse is one of the most pressing health issues in the United States today. Consequently, analgesic adjuncts, such as multimodal drug regimens and regional anesthetic blocks (like transversus abdominis plane (TAP) block), have been introduced to the perioperative period in hopes of decreasing postoperative opiate use. However, the effect of these interventions on intraoperative opiate use has not been examined. We hypothesized that preoperative TAP block would be associated with decreased intraoperative opiate use during minimally invasive cholecystectomy. This was a retrospective review of patients undergoing minimally invasive cholecystectomy between June 2018 and January 2021. Perioperative data, operative times, and medication administration data were collected. Intraoperative opiate use was calculated in total morphine equivalent doses (MED) for each patient and adjusted for operative time. Univariate analysis and multivariate linear regression were performed to determine factors affecting intraoperative opiate requirements. 261 patients were included in this study, of which 62 (23.8%) received preoperative TAP block and 199 (76.2%) did not. Preoperative TAP block was associated with decreased intraoperative opiate use (0.199 vs 0.312, p < 0.001), while there were no statistically significant differences associated with other analgesic adjuncts including preoperative acetaminophen (p = 0.485), celecoxib (p = 0.112), gabapentin (p = 0.165), or intraoperative ketorolac (p = 0.200). On multivariate analysis, preoperative TAP block was independently associated with decreased intraoperative opiate use (< 0.001), while chronic cholecystitis on final pathology was associated with increased intraoperative opiate use (p = 0.002). The use of preoperative TAP block was associated with decreased intraoperative opiate use during minimally invasive cholecystectomy and should be considered for routine use. Future research should investigate whether preoperative TAP blocks and a subsequent decrease of intraoperative opiates, also result in a decrease in postoperative opiate use and improvements in postoperative outcomes.

Comparative analysis of opioid use between robotic and open pancreatoduodenectomy.

Risk-stratified pancreatectomy clinical pathways using regional anesthesia and multimodality analgesia have decreased overall opioid use, but the additional benefits of robotic surgery in opioid reduction for pancreatoduodenectomy (PD) are unknown. We compared the inpatient opioid use between robotic PD and open PD. Patients undergoing open PD within a protocol evaluating preincisional regional anesthetic block bundles were compared to consecutively-treated patients undergoing robotic PD identified from a prospectively maintained single-institutional database. Clinical characteristics, operative outcomes, pain scores and inpatient oral morphine equivalent (OME) use were compared between patients treated with robotic or open PD. Patients with a history of continuous-release opioid dependence were excluded. Of 114 total patients, 25 underwent robotic PD and 89 underwent open PD. Intraoperative opioid use was not different (P=.87), nor were cumulative pain scores. Robotic PD patients used significantly fewer OMEs per day on postoperative days 1-4 (P=.039), used fewer total OMEs during hospitalization (robotic: median=79, IQR 42.5-141; open: median=126, IQR 61.3-203.8; P=.0036) and were discharged with fewer OMEs (robotic: median=0, IQR 0-43.8; open: median=25, IQR 0-75; P=.009) despite a shorter length of stay (robotic: median=4, open: median=5, P=.002). Robotic PD patients required fewer inpatient OMEs than open PD while maintaining similar pain scores. A higher percentage of robotic PD patients tapered off of opioids prior to discharge than open surgery patients treated with a standardized opioid reduction protocol despite a shorter length of stay. These results provide a rationale for choosing robotic PD when feasible to minimize opioid use.

Vessel loop tourniquet for penis dermatologic surgery

A 55-year-old man presented to our dermatology department with a squamous cell carcinoma of the foreskin (Fig 1). The planned treatment consisted of an extended circumcision using the sleeve technique.1 Regional block anesthesia was performed by infiltrating the dorsal nerves of the penis with 2% mepivacaine in the subfascial plane. The penis is a highly vascularized organ and the use of vasoconstrictors such as epinephrine is not recommended during penile regional block. How could bleeding during penis dermatologic surgery be minimized?

Tension-free inguinal hernia repair with transversus abdominis plane (TAP) block in elderly high-risk patients.

Inguinal hernia repair is still being studied today because it is one of the most commonly performed surgical procedures in the world and is used in people of all ages. Although many centers use spinal anesthetic to treat inguinal hernias, complications such as hypotension from peripheral vasodilation, delayed mobilization from paralysis, urine retention and post-spinal headache might occur. Regional blocks are a significant component of multimodal anaesthesia that promotes postoperative recovery. Transversus abdominis plane (TAP) block is a regional anesthetic block technique that is effective on the parietal peritoneum, skin, and anterior abdominal wall. This study aimed to show that TAP block administration may be done safely without the use of an extra anesthetic treatment, especially in older patients who may experience complications from general or spinal anesthesia. Without either general, spinal or epidural anesthetic, we conducted a tension-free - Lichtenstein - inguinal hernia repair operation with only TAP block application. This retrospective case-control study received ethics committee approval (decision number 21-5T/108). Between September and December 2019, patients who underwent elective Lichtenstein hernia repair in our clinic were evaluated retrospectively. We think that inguinal hernia repair can be safely performed with only TAP block and that TAP block application has fewer anaesthesia-related complications such as postspinal headache and urinary retention compared with spinal anaesthesia, and that it can be used as an alternative to spinal anaesthesia in patients who cannot tolerate general anaesthesia. Even hernia surgery can be very challenging in patients with advanced age and comorbidities. We wanted to show the feasibility of the TAP block method as an alternative to anaesthesia in such patients.

Quality care guidelines for uterine artery embolisation in women with symptomatic uterine fibroids in Australia and New Zealand: According to the AGREE-II checklist and endorsed by the Interventional Radiology Society of Australasia.

Quality care guidelines for uterine artery embolisation in women with symptomatic uterine fibroids in Australia and New Zealand: According to the AGREE-II checklist and endorsed by the Interventional Radiology Society of Australasia.

Preoperative transversus abdominis plane block decreases intraoperative opiate use during pancreatoduodenectomy.

Multimodal analgesia and regional anesthetic blocks, such as transversus abdominis plane (TAP) block, decrease postoperative opiate consumption but their effect on intraoperative opiates is unknown. This was a retrospective review of patients undergoing pancreatoduodenectomy between June 2018 and February 2021, in which perioperative data, operative times, and medication administration data were collected. Intraoperative opiate use was calculated in total morphine equivalent doses (MED) for each patient and adjusted for operative time. Univariate analysis and multivariate linear regression were performed to determine factors affecting intraoperative opiate requirements. Of the 169 patients in the study, 51 (30.2%) received pre-surgical TAP blocks and 118 (69.8%) did not. There were no statistically significant differences in intraoperative opiate use with preoperative acetaminophen (p=0.527), celecoxib (p=0.553), gabapentin (p=0.308), intraoperative ketorolac (p=0.698) or epidural placement (p=0.086). Minimally invasive surgery had lower intraoperative opiate use compared to open (p=0.011), as well as pre-surgical TAP block compared to no pre-surgical block (5.24 vs 7.27 MED/hour, p<0.001). On multivariate linear regression, pre-surgical TAP block (p=0.001) was independently associated with decreased intraoperative opiate use. Preoperative TAP blocks were associated with decreased intraoperative opiate use during pancreatoduodenectomy and should be considered for routine use.

Quadratus Lumborum Block for Upper Tract Urological Surgery in Pediatric Patients

Abstract Objective Among regional blocks, the quadratus lumborum fascial plane block (QLB) has been well described, but the description of its use and efficacy for pediatric patients undergoing upper abdominal urologic surgery is limited. We present a case series examining the use of the QLB for postoperative pain management in children undergoing upper tract surgery. Methods From August 2019 to August 2020, through a chart review, we identified 5 patients who had undergone a QLB for upper urinary tract surgery via a flank incision. Posterior QLB was performed after induction of general anesthesia. A single injection of 0.5mL/kg of either 0.25% or 0.5% ropivacaine with 1mcg/kg of clonidine was administered. Patients received fentanyl IV (1 mcg/kg), and acetaminophen IV (15mg/kg) as adjuvants during the operation. Postoperative pain was managed with oral acetaminophen and ibuprofen. Results The average postoperative pain score during the entire admission was 1, with the lowest being 0 and highest, 3. No administration of rescue narcotics was required in the postanesthesia care unit or on the floor. The average length of stay ranged from 0 to 1 day. No complications associated with the regional QLB were identified. Conclusions Our series suggests the QLB may be considered as a regional anesthetic option to minimize narcotic requirements for children undergoing upper abdominal urological surgery via flank incision. Additional studies are needed to compare the efficacy of the QLB versus alternate regional anesthetic blocks for upper tract urological surgery via flank incision in children and to determine effective dosing and use of adjuvants.

How Should Anesthesiologists Face Coronavirus Disease 2019?

Coronavirus disease 2019 (COVID-19) is a highly contagious disease. Most infected patients manifest mild flu-like symptoms, but in some cases, the patients rapidly develop severe lung infections and pneumonia. It is estimated that about 15–20% of patients with COVID-19 develop hypoxemia and require some form of oxygen therapy and ventilation support. Further, exacerbation of the disease usually requires an emergency tracheal intubation, where the patients are more prone to coughing and aerosol diffusion, placing the anesthesiologist at an extremely high risk of infection. In this review, after a brief introduction to the epidemiology and pathogenesis of the COVID-19, we describe various recommendations that the anesthesiologists should employ to avoid the chances of infection during the management of severely ill patients. We describe key steps such as not removing the patient's mask prematurely and using sedatives, analgesics, and muscle relaxants for rapid and orderly intubation. The use of spinal cord and regional nerve block anesthesia should also be promoted to avoid general anesthesia. Since the patients with COVID-19 may also have disorders related to other parts of the body (other than lungs), short-acting drugs are recommended to actively maintain the perfusion pressure of the peripheral and important organs without metabolism of the drugs by the liver and kidney. Multimodal analgesia is advocated, and non-steroidal anti-inflammatory analgesic drugs can be used appropriately. In this review, we also discuss key studies and experiences of anesthesiologists from China, highlights research findings, and inform on the proper management of patients with perspective on anesthesiologists.

A Novel Sacral Erector Spinae Block Reduces Opioid Use After Gender-affirming Vaginoplasty

ABSTRACT Introduction Surgeries that affirm a person's gender identity can be the ultimate end to the distress associated with the discordance between one's gender identity and sex assigned at birth. Gender-affirming vaginoplasty (GAV) is increasingly being performed as a critical component of gender transition for individuals assigned male at birth transitioning to female. As GAV becomes offered at more centers around the United States (US), it is important to understand and consider surgical outcomes that are unique to this operation without losing sight of the larger context of surgical care in the US. In this vain, it is known that post-surgery prescriptions for opioids are a catalyst for opioid addiction in nearly 1 in 16 surgery patients; furthermore, individuals with gender dysphoria are twice as likely to abuse prescription opioids. Regional anesthetic blocks have been adopted in many urologic surgeries to reduce opioid consumption both during and after surgery. The sacral erector spinae plane block (ESP) is a novel block that can block the S2-S4 pain levels in addition to some of the lumbar plexus with benefits over a neuraxial/epidural block including being a superficial block, no significant motor weakness, reduced risk of epidural hematoma, and less risk of intraoperative hemodynamic lability. Objective We sought to review complications and opioid usage after a novel sacral erector spinae plane block as an adjunct for pain control in the perioperative period in patients undergoing robotic-assisted penile inversion vaginoplasty. Methods We reviewed all charts of patients undergoing robotic-assisted penile inversion vaginoplasty or vulvoplasty at our institution. On the morning of surgery, patients were placed in a prone position and administered midazolam and fentanyl for sedation. Median sacral crests and the erector spinae muscle/plane (ESP) were identified using ultrasound guidance, and 0.2% ropivacaine was injected at the S4 and S2 sacral crest. Results A total of 13 patients received the ESP block. There were no complications either in the immediate post-block period or after surgery related to the block. Mean opioid consumption in the first 24 hours after surgery, 24-48hr, 48-72hr, 72-96hr, and 96-120 hours after surgery were 29.1, 50.9, 46.0, 36.5, and 38.7 oral morphine equivalents (OMEs), respectively. There was a significantly reduced amount of OME consumption in the 24 hours after surgery compared to the 24-48 hour period (p=0.017). Conclusions Sacral erector spinae plane block is a safe and efficacious way to reduce opioid consumption in the postoperative period after gender-affirming robotic-assisted penile inversion vaginoplasty or vulvoplasty. Disclosure No

29 Efficacy of a Novel LAM Femoral Cutaneous Block Technique for Acute Donor Site Pain

IntroductionPatients with severe burn injuries often require split thickness skin grafting to expedite would healing with the thigh being a common donor site. Uncontrolled pain is associated with increased opioid consumption, longer lengths of stay, and delay in functional recovery. Regional nerve blocks are increasing in popularity although supportive literature is limited, and techniques vary. Recently, we presented a case demonstrating a novel LAM (lateral, anterior, medial) femoral cutaneous block technique. The purpose of the case series is to assess the safety, feasibility, and clinical efficacy in a larger cohort.MethodsThe study was a dual IRB approved, observational case series from a single verified burn center. The electronic health record was retrospectively reviewed for patients admitted between June 2018 to June 2020 who had the LAM block placed for donor site pain by the acute pain service (APS) team. Patient demographics, and data pertinent to the LAM regional anesthesia block were collected (eg opioid usage before and after the block, pain, and physical therapy outcomes). The data were tabulated and analyzed using Microsoft Excel© and SPSS version 27.0. Descriptive statistics were utilized to describe the patient demographics and LAM block feasibility & safety. Morphine Milligram Equivalent (MME) were statistically compared utilizing repeated measures ANOVA on ranks and graphically presented.ResultsTwenty-four patients had total of 27 blocks placed, where 3 patients received the LAM block on two separate occasions. One patient had bilateral LAM blocks placed and was included as the single instance for the analysis. The majority were Caucasian males, but mechanism of injury varied. Two-thirds had a neurologic or psychiatric history. Seventy-one percent used tobacco and a quarter had a history of polysubstance abuse. Median area of the donor site was 360 cm2 (207, 1140). Median day from admission to LAM was 8 (3, 12) with a median duration of 4 (3, 5) days. Median day until first ambulation after LAM was 3 (1,3). Eighty percent reported a decreased temperature sensation at the donor site. Pain was adequately controlled, and there were no adverse events or quadricep weakness noted. There was a significant reduction in MME after block placement (Figure 1).ConclusionsRegional nerve blocks offer an advantageous means of analgesia, while reducing potential adverse events associated with opioids. While the novel LAM technique reduced some sensation, early ambulation was not inhibited and patients able to participate with rehabilitation therapy.

Considerations Anesthesia Management for Cesarean Section in Pregnancy With COVID 19 - Severe ARDS: A Case Report

Background: Corona Virus Disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), was labeled a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO) on January 30, 2020. SARS-CoV-2, a new type of enveloped RNA RNA virus, can be transmitted from human to human through droplets and contact. As of May 27, 2020, more than 5.6 million confirmed cases have been documented globally, with over 350,000 deaths. Anatomical, physiological changes in pregnancy, especially in the cardiorespiratory system, make pregnant women more susceptible to COVID-19 infection and cause more serious complications. Severe ARDS is a form of manifestation that often occurs in the peripartum period. Severe complications in pregnancy such as premature birth, fetal death in utero, intensive care unit have been reported. Case: A 31 Year old female with 3rd pregnancy, 26-27 weeks of gestation, accompanied by a locus minoris, a former cesarean section infected with severe COVID-19 with ARDS, complaining of reduced fetal movement after undergoing treatment in the covid isolation room for 24 hours and successful management of anesthesia with regional subarachnoid block anesthesia. Conclusion: In perioperative management, especially in optimizing the cardiorespiratory system, professionals in anesthetic management and multidisciplinary cooperation are important in managing this patient.

Regional Scalp Blockade for Painless Removal ofIntracranial Pressure Bolts: Technical Note and Patient-Reported Outcomes

Elective insertion of intracranial pressure (ICP) monitoring bolts is useful for the diagnosis and treatment of disorders of cerebrospinal fluid dynamics. Patients typically report severe discomfort on bolt removal, which negatively impacts overall patient satisfaction of ICP monitoring. We assessed the efficacy and safety of using supratrochlear and supraorbital nerve block-a commonly used form of scalp anesthesia-alongside oral analgesia before bolt removal. We compared the efficacy and safety of regional scalp block anesthesia alongside oral analgesia versus oral analgesia alone in a cohort of 85 patients undergoing removal of diagnostic ICP bolts between June 2017 and April 2019 using retrospective patient questionnaires, as well as electronic admission documentation. We found that scalp block alongside oral analgesia improved bolt removal experience (4/5 vs. 3/5 on a 1-5 point Likert scale) and that a majority (70.6%) of patients would have preferred local anesthetic before removal in the oral analgesia-only group. Only 2 patients experienced mild and localized side effects: mild bruising and temporary facial and eyelid swelling following regional scalp block. We conclude that regional supraorbital and supratrochlear nerve block is a simple, safe, and effective adjunct to minimizing discomfort during bolt removal and improving overall patient satisfaction of ICP monitoring.

Anesthesia With Propofol Sedation Reduces Locoregional Recurrence in Patients With Breast Cancer Receiving Total Mastectomy Compared With Non-Propofol Anesthesia.

PurposeWe examined locoregional recurrence (LRR) in patients with breast invasive ductal carcinoma (IDC) receiving total mastectomy (TM) under propofol-based paravertebral block-regional anesthesia (PB-RA) versus sevoflurane-based inhalational general anesthesia (INHA-GA) without propofol. All-cause death and distant metastasis were secondary endpoints.Patients and MethodsPatients with breast IDC receiving TM were recruited through propensity score matching and categorized into INHA-GA with sevoflurane and PB-RA with propofol groups. Cox regression analysis was performed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsIn the multivariate Cox regression analysis, the adjusted HR (aHR; 95% CI) of LRR for the PB-RA with propofol group was 0.52 (0.28–0.96) compared with the INHA-GA with sevoflurane group. The aHRs of LRR for differentiation grade II, grade III, the American Joint Committee on Cancer clinical stage II, stage III, pathological tumor (pT) stage 2, pT stage 3–4, pathological nodal (pN) stage 1, and pN stage 2–3 were 1.16 (1.04–2.08), 1.28 (1.07–2.12), 3.71 (1.82–7.59), 4.67 (1.65–13.18), 1.09 (1.02–1.21), 1.17 (1.03–2.16), 1.10 (1.03–1.33), and 1.22 (1.06–2.41), respectively, compared with differentiation grade I, clinical stage I, pT1, and pN0. The aHR of LRR for adjuvant RT was 0.88 (0.64–0.94) compared with that for no adjuvant RT.ConclusionPB-RA with propofol might be beneficial for reducing LRR in women with breast IDC receiving TM compared with INHA-GA without propofol.