Article Text
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.
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.
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