AB280. SOH26AB_0204. Improving recovery in breast-conserving surgery: an audit of local anaesthetic infiltration, pain, and opioid use at University Hospital Limerick

Background: Breast-conserving surgery (wide local excision) is a major component of breast cancer care in Ireland. Effective analgesia supports mobilisation and reduces opioid-related side effects. National guidelines [Irish Pain Society, The National Institute for Health and Care Excellence (NICE)] recommend multimodal, opioid-sparing strategies, while PROSPECT (2023) advises adding pectoral nerve II (PECS II) or erector spinae plane (ESP) blocks. This audit aimed to assess whether surgeon-delivered local anaesthetic (LA) infiltration alone provides adequate analgesia and examined associations with pain, opioid use, postoperative nausea and vomiting (PONV), and anaesthetic technique.

Methods: A retrospective review of 50 consecutive wide local excisions [2025] was performed. Standard practice included infiltration with 0.25% levobupivacaine (30–40 mL), paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), dexamethasone, and ondansetron. Anaesthesia was classified as sevoflurane-based or total intravenous anaesthesia (TIVA). Data were extracted from anaesthetic charts, National Early Warning Score (NEWS) observations, and Kardex records. Variables included LA dose (mg/kg), pain scores at 1, 6, and 24 hours, opioid use, and PONV. Non-parametric tests were applied.

Results: Sevoflurane was used in 33 cases (66%) and TIVA in 17 (34%). Mean LA dose was 1.14±0.32 mg/kg. Postoperative opioids were required in 42% of patients, and PONV occurred in 14%. Moderate pain (≥3/10) occurred in 44% at 1 hour, 26% at 6 hours, and 10% at 24 hours. LA dose did not correlate with pain (ρ=−0.19 to −0.04; P>0.18). There was no significant correlation between LA dose and postoperative morphine use (ρ=0.15, P=0.29). Opioid use was slightly lower with TIVA (41%) vs. sevoflurane (49%), and PONV showed a similar trend (12% vs. 15%).

Conclusions: Local infiltration (~1.1 mg/kg) reduced late pain but did not reliably prevent early pain or opioid use. Outcomes were similar between techniques, with small trends favouring TIVA. The lack of dose–response effect suggests infiltration alone is insufficient; adding PECS II or ESP blocks may improve analgesic consistency and align with guideline recommendations.

Keywords: Local anaesthetic (LA); postoperative pain; opioid consumption; regional analgesia; breast surgery