TIVA is defined as Total Intravenous Anesthesia. This has been a technique that has been around for many years and is gaining popularity. TIVA is not only used in plastic surgery, but in many types of surgeries because of the advantages it offers. The technique is performed without placing a breathing tube in the throat. TIVA is still technically a general anesthesia, but one without inhalation gas. The anesthetic is administered through the vein only. The advantages of this technique is that it has a safety profile superior to inhalation anesthesia. With TIVA, the chance of DTV or deep venous thrombosis significantly decreases. DVT, which can create blood clots in the lungs, poses a dangerous health risk, that can even be fatal. The other advantage of the technique is a significant improvement in post-operative pain control. The technique usually uses a local anesthetic nerve block around the area that is operated on that can provide pain control not only during surgery, but also many hours afterwards. Patients who undergo surgery with me sometimes comment that their surgery pain is significantly less than what they hear from other patients. TIVA can be used during a variety of procedures including breast augmentation, liposuction, and tummy tuck and can provide a much more pleasant recovery and minimize the need of post-operative pain medication. Nevertheless, there are also disadvantages to TIVA. If someone has certain medical conditions or frequently uses chronic narcotics or alcohol, the technique can be less effective. Another disadvantage of the technique is that it is labor-intensive for the surgeon. The surgeon typically places the local anesthetic nerve blocks, and some surgeons do not like to take the time, or effort to do this. I have presented this technique of total intravenous anesthesia with local anesthetic nerve blocks for tummy tucks at the most recent Texas Society of Plastic Surgeons annual meeting in September of 2014.