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Paravertebral and erector spinae plane blocks decrease length of stay compared with local infiltration analgesia in autologous breast reconstruction
  1. Haripriya S Ayyala1,
  2. Melissa Assel2,
  3. Joseph Aloise3,
  4. Joanna Serafin4,
  5. Kay See Tan2,
  6. Meghana Mehta5,
  7. Vinay Puttanniah4,
  8. Patrick McCormick4,
  9. Vivek Malhotra4,
  10. Andrew Vickers2,
  11. Evan Matros6 and
  12. Emily Lin4
  1. 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
  2. 2Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  3. 3Department of Operational Excellence, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  4. 4Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  5. 5Digital Informatics & Technology Solutions Department, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  6. 6Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  1. Correspondence to Dr Emily Lin, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; line{at}mskcc.org

Abstract

Background Autologous breast reconstruction is associated with significant pain impeding early recovery. Our objective was to evaluate the impact of replacing surgeon-administered local infiltration with preoperative paravertebral (PVB) and erector spinae plane (ESP) blocks for latissimus dorsi myocutaneous flap reconstruction.

Methods Patients who underwent mastectomy with latissimus flap reconstruction from 2018 to 2022 were included in three groups: local infiltration, PVB, and ESP blocks. Block effect on postoperative length of stay (LOS) and the association between block status and pain, opioid consumption, time to first analgesic, and postoperative antiemetic administration were assessed.

Results 122 patients met the inclusion criteria for this retrospective cohort study: no block (n=72), PVB (n=26), and ESP (n=24). On adjusted analysis, those who received a PVB block had a 20-hour shorter postoperative stay (95% CI 11 to 30; p<0.001); those who received ESP had a 24-hour (95% CI 15 to 34; p<0.001) shorter postoperative stay compared with the no block group, respectively. Using either block was associated with a reduction in intraoperative opioids (23 morphine milligram equivalents (MME)), 95% CI 14 to 31, p<0.001; ESP versus no block: 23 MME, 95% CI 14 to 32, p<0.001).

Conclusions Replacing surgical infiltration with PVB and ESP blocks for autologous breast reconstruction reduces LOS. The comparable reduction in LOS suggests that ESP may be a viable alternative to PVB in patients undergoing latissimus flap breast reconstruction following mastectomy. Further research should investigate whether ESP or PVB have better patient outcomes in complex breast reconstruction.

  • analgesia
  • Pain Management
  • Nerve Block
  • Anesthesia, Local
  • Acute Pain

Data availability statement

No data are available. The authors choose not to participate in data sharing at this time.

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Data availability statement

No data are available. The authors choose not to participate in data sharing at this time.

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Footnotes

  • Contributors HSA helped with study conceptualization, clinical content, manuscript writing and editing; MA helped with study design, data analysis, manuscript writing and editing; JA helped with data preparation and manuscript editing; JS with data preparation, manuscript writing and editing; KST helped with study design, data analysis, manuscript writing and editing; MM helped with data preparation and manuscript editing; VP helped with clinical content and manuscript editing; PM helped with clinical content and manuscript editing; VM helped with clinical content and manuscript editing; AV helped with data analysis, manuscript writing and editing; EM helped with clinical content and manuscript editing; EL is the content guarantor and accepts full responsibility for the work and/or the conduct of the study; worked extensively on conceptualizing the study, data and analysis review, manuscript writing and editing and controlled the decision to publish.

  • Funding This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.