title: Breast augmentation and augmentation-mastopexy with local anesthesia and intravenous sedation.
abstract: BACKGROUND
  Administration of intravenous sedation and intercostal nerve blocks has resulted in reduced postoperative nausea and faster recovery as compared to general anesthesia.
  
  
  OBJECTIVE
  The authors present their experience with intercostal nerve blocks and intravenous sedation in breast augmentation, with and without simultaneous mastopexy. Their protocol does not include propofol and thus can be administered by the surgeon and circulating nurse.
  
  
  METHODS
  The initial dose of intravenous sedation was administered by the surgeon, starting with midazolam, fentanyl, and ketamine; additional doses (as needed) were given by the circulating nurse. Local anesthesia blocks were injected into Intercostal Spaces 3-7 at the midaxillary line. The anesthetic solution was injected at the lateral sternal boarder in varying amounts. A retrospective review was performed of 171 patients who underwent bilateral breast augmentation or augmentation-mastopexy with this protocol. The two groups were analyzed for age, body mass index, operating time, total amount of sedation/anesthesia, recovery room time, postoperative nausea, and complications.
  
  
  RESULTS
  Of the 171 patients, 132 underwent augmentation and 39 had augmentation-mastopexy. All recovered well from anesthesia. The mean recovery room time was 49.9 minutes for the augmentation group and 52.9 minutes for the augmentation-mastopexy group. Postoperative nausea occurred in 14 (10.6%) patients who received augmentation alone and in five (12.8%) who underwent augmentation-mastopexy. There were no serious complications or hospital admissions.
  
  
  CONCLUSIONS
  Breast augmentation with or without mastopexy can be performed safely, with minimal discomfort and complications, by employing local anesthesia with intravenous sedation. Although augmentation-mastopexy requires more operating time than augmentation alone, the recovery times are comparable.
authors.affiliation: The Methodist Hospital, Houston, Texas, USA. apcolque@hotmail.com
authors.forename: Alex
authors.initials: A
authors.lastname: Colque
authors.forename: Michael L
authors.initials: ML
authors.lastname: Eisemann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D000772:Anesthesia, Local / Q000379:methods; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D019928:Breast Implantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007367:Intercostal Nerves; D007649:Ketamine / Q000008:administration & dosage; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D007649:Ketamine; D008874:Midazolam; D005283:Fentanyl