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Abstract
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Background and Aims At our centre, we perform ~160 mastectomies annually, with ~50% receiving paravertebral (PVB) or erector spinae plane (ESP) block. Our aim was to conduct a baseline audit of our current practice to quantify post-operative pain outcomes. This could then inform implemented change, with the aim of improving pain outcomes.
Methods Over a 3-month period, we audited 20 patients undergoing mastectomy or mammoplasty. 10 patients received general anaesthesia (GA) with PVB/ESP block. 10 patients received GA with local anaesthesia (LA) infiltrated surgically. Data was collected both prospectively and retrospectively. The key outcomes were - failed day case rate, intra and post-operative opioid requirement, pain scores immediately after surgery, on discharge, day 1 and day 2. Our local audit department authorised this project, confirming it did not require Ethical Committee approval.
Results 3 out of 10 cases that received GA+LA required unplanned inpatient admission due to inadequately controlled pain post-operatively. There were no such cases in the GA+PVB/ESP group. See graphs 1 and 2 for further results.
Conclusions Our data shows that patients undergoing mastectomy or mammoplasty that received GA+PVB/ESP had reduced intra and post-operative opioid requirements, reduced pain scores up to 48 hours post-operatively as well as being less likely for day case failure due to inadequate analgesia, in comparison to those patients that received GA+LA. After achieving our aim from this initial audit, we will present this data at our clinical governance meeting. Recommendations for change will include PVB and ESP block training, following which we plan to re-audit to measure any improvement.
Results - Post-operative pain scores following major breast surgery
Results - Opioid requirement in major breast surgery