Operationalizing an evidence based anesthetic technique for breast cancer surgery

Purpose

Breast cancer is the second leading cause of death in women over 40 in the United States. Evidence demonstrates that for these patients undergoing surgery, the choice of anesthesia technique can influence outcomes and recurrence rates. The purpose of this project was to implement an evidence-based anesthesia technique for breast cancer surgery at Appalachian Regional Healthcare System (ARHS).

Methodology

Using Stetler’s Model of Evidence Based Practice, unit-level inservices were given to certified registered nurse anesthetists, and physician anesthesiologists and general surgeons were guided on an individual basis. The technique implemented was the introduction of regional anesthesia in the form of pectoral nerve blocks (PECs), the use of propofol-based total intravenous general anesthesia, and the avoidance of intraoperative opioids. Data was collected for the implementation of this technique for anesthesia providers to patients presenting to ARHS for mastectomy and breast biopsy with sentinel lymph node biopsy.

Results

Two patients did not receive PECs blocks; one patient did not receive a propofol-based anesthetic; and 8 out of 36 patients received opioids. The goal of data collection for this project was 40 patients. 36 patients were subject to the protocol during the project period. Feedback from the general surgeons and patients has been positive: The general surgeons forward compliments of tolerable pain controlled at home without the use opioids.

Implications

The review of outcome variables has resulted in changes at ARHS. As the project continues, the following changes are anticipated: the addition of erector spinae blocks to provide anesthesia to the axilla; new provider orientation checklist; and the creation of a service line position.