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Abstract
Background and Aims Pain associated with major breast surgery can be severe. Recent PROSPECT guidelines recommend regional anaesthesia (RA) for postoperative pain management1 but single shot blocks are limited in duration (<24 hours). We have introduced a continuous ambulatory local anaesthestic (LA) infusion through serratus plane catheters (SPC) as part of our enhanced recovery pathway for mastectomies to extend the benefits of RA.
Methods We conducted a prospective case review of 29 mastectomies (October 2021 - March 2022) who received the ambulatory infusion. All patients had a surgically inserted SPC and discharged on a continuous infusion of 0.125% levobupivacaine (4–6 ml/hr) for 48 hours.
Results All patients received preoperative RA blocks (pectoral nerve group ± paravertebral), SPC (loaded with 10 mls 0.25% bupivacaine) and surgical LA infiltration. Intraoperatively they all received multimodal analgesia and IV dexamethasone.
Median pain scores in recovery, post-op day 1 and day 2 were low (0 (IQR 0–2), 1 (IQR 1–3) and 2 (IQR 0–3) respectively - figure 1). Sleep quality was excellent with 90% having no pain overnight on day 1 and 83% on day 2 (figure 2). 12 patients were discharged on PRN weak opioids (11 Codeine, 1 Tramadol), and no patients required strong opioids on discharge. There were no readmissions due to inadequate analgesia.
Conclusions Our case series demonstrates the potential benefit of continuous SPC in extending the duration of RA , which may mitigate against rebound pain once the primary RA wears off. We recommend this technique as part of a balanced, multimodal post-operative analgesic plan for major oncological breast surgery.