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Paravertebral Blocks Reduce Narcotic Use Without Affecting Perfusion in Patients Undergoing Autologous Breast Reconstruction

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Autologous breast reconstruction offers excellent long term outcomes after mastectomy. However, maintaining adequate postoperative analgesia remains challenging. Use of paravertebral blocks (PVBs) reduces postoperative narcotic use and length of stay, and enhanced recovery protocols with mixed analgesia methods are gaining popularity, but few studies have explored the intraoperative effects of these interventions.

Methods

Patients who underwent abdominally based autologous breast reconstruction between 2010 and 2016 were compiled into a retrospective database. We used electronic medical records to determine demographics, as well as perioperative and intraoperative vital signs and narcotic, anxiolytic, crystalloid, colloid, blood product, and vasopressor requirements, and postoperative complications. Results were compared between patients who had a PVB and those who did not and those who had a PVB alone and those who followed our enhanced recovery protocol using standard statistical methods and adjusting for preoperative values.

Results

A total of 170 patients were included in the study. Sixty-six had a PVB, and 104 did not. Of the 66 who had a PVB, 19 followed our enhanced recovery protocol. Patients who did not have a PVB required 171.6 mg of total narcotic medication in the perioperative period, those with a PVB alone required 146.9 mg, and those who followed the ERAS protocol 95.2 mg (p = 0.01). There was no difference in intraoperative mean arterial pressure, time with mean arterial pressure <80% of baseline, vasopressor use, or fluid requirement. There was no difference in complication rate.

Conclusions

PVBs and an enhanced recovery protocol reduce the use of narcotic medications in autologous breast reconstruction without impacting intraoperative hemodynamics. Breast reconstruction after mastectomy restores body image and improves health-related quality of life, satisfaction with appearance and physical, psychosocial, and sexual well-being (Donovan et al. in J Clin Oncol 7(7):959–968, 1989; Eltahir et al. in Plast Reconstr Surg 132(2):201e–209e, 2013; Jagsi et al. in Ann Surg 261(6):1198–1206, 2015). For patients pursuing breast reconstruction, there are two major options: prosthetic (tissue expander/implant) or autologous reconstruction. However, while providing exceptional long-term outcomes, postoperative pain and length of hospital stay remains a major challenge preventing more widespread adoption of autologous breast reconstruction (Albornoz et al. in Plast Reconstr Surg 131(1):15–23, 2013; Gurunluoglu et al. in Ann Plast Surg 70(1):103–110, 2013; Kulkarni et al. in Plast Reconstr Surg 132(3):534–541, 2013; Sbitany et al. in Plast Reconstr Surg 124(6):1781–1789, 2009). Acute postoperative pain contributes to prolonged hospital stays, increased narcotic use, and associated risks of the aforementioned.

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Disclosures

This research was supported by T32CA190194 (PI: Colditz, funding for EO) and by the Foundation for Barnes-Jewish Hospital and by Siteman Cancer Center. The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH. Other authors have no financial disclosures or conflicts of interest.

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Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Elizabeth B. Odom MD, Rajiv P. Parikh MD & Terence M. Myckatyn MD, FACS

  2. Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA

    Nili Mehta MD & Ryan Guffey MD

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  1. Elizabeth B. Odom MD
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  2. Nili Mehta MD
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  3. Rajiv P. Parikh MD
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  5. Terence M. Myckatyn MD, FACS
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Correspondence to Terence M. Myckatyn MD, FACS.

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Odom, E.B., Mehta, N., Parikh, R.P. et al. Paravertebral Blocks Reduce Narcotic Use Without Affecting Perfusion in Patients Undergoing Autologous Breast Reconstruction. Ann Surg Oncol 24, 3180–3187 (2017). https://doi.org/10.1245/s10434-017-6007-z

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