Thread by @nickdblack

There has been lots of twitter chat about this paper, after reading the full text I have a few thoughts

#TIVAparavert vs #SevoMorph

@amit_pawa @LloydTurbitt @davejohnston24 @rosie_hogg @harry74 @johncampbell01 @PeterMerjavy @ariijbooley @jonnymcc22 @CiaraPepe

1/x

1) This paper is important, read it

2) This is a large, prospective, multi-centre RCT trying to figure out if how we deliver anaesthesia can prevent cancer mets / recurrence – that would be amazing (even asking the question is amazing)

2/x

3) There might be lots of bias in this arena, those who do blocks and TIVA (#LikeMe) might want their practice validated

4) Those who give volatiles for these cases might equally want practice validated

3/x

5) The trial does not suggest there was additional harm in either group (in cancer terms)

6) In my experience a lot of people want a general anaesthetic for breast surgery – they also don't generally want to be in hospital long.

4/x

7) This study backs up previous retrospective work, Yoo. Et al’s 2019 paper of >7500 patients.

8) We don’t know if this study applies to all types of cancer, or just breast. But there is some retrospective work showing TIVA benefit elsewhere (eg Wigmore et al 2016)

5/x

9) There are other benefits of #TIVA (Not just PONV), see Miller et al's Cochrane review 2018 – it might reduce POCD in the elderly (OR 0.52 --> 0.31 to 0.87)

10) Wong et al 2018 - #TIVA may reduce opioid consumption after colorectal surgery

6/x

11) Let’s not even get into #PECS2 or #SerratusAnt or whatever plane block is popular atm, let’s leave that for another day

12) The RA group did not have less persistent incision pain

7/x

So what will you do for your next breast cancer case????

I would love to hear your thoughts, here/DM/tea room whatever.

And I got through this whole thing without mentioning how volatiles are bad for the environment.....