Paravertebral block associated with decreased opioid use and less nausea and vomiting after reduction mammaplasty

Rivedal, David; Nayar, Harry S.; Israel, Jacqueline S.; Leverson, Glen; Schulz, Andrew J.; Chambers, Tamara; Afifi, Ahmed M.; Blake, Jocelyn M.; Poore, Samuel O.

doi:10.1016/j.jss.2018.03.018

Cited by 23 publications

(23 citation statements)

References 24 publications

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“…While there may have been selection bias, the finding that PVB did not significantly decrease opioid use is not surprising. Previous studies demonstrate that PVB use is linked to the decreased intraoperative and immediate postoperative intravenous opioid use . However, studies have not been able to demonstrate that PVB use translates to a long‐term decrease in opioid use or analgesic benefits …”

Section: Discussionmentioning

confidence: 99%

“…Previous studies demonstrate that PVB use is linked to the decreased intraoperative and immediate postoperative intravenous opioid use. 29,30 However, studies have not been able to demonstrate that PVB use translates to a long-term decrease in opioid use or analgesic benefits. 30,31 Although efforts have been made to identify patients at risk for persistent pain after breast surgery, the relationship between persistent pain and chronic opioid use has not been delineated.…”

mentioning

confidence: 99%

“…29,30 However, studies have not been able to demonstrate that PVB use translates to a long-term decrease in opioid use or analgesic benefits. 30,31 Although efforts have been made to identify patients at risk for persistent pain after breast surgery, the relationship between persistent pain and chronic opioid use has not been delineated. 32 Previous studies have shown that patient psychological characteristics (psychological "robustness" and tolerance of pain) can profoundly impact perception of pain and other symptoms as a consequence of breast surgery.…”

mentioning

confidence: 99%

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Surgeon perception versus reality: Opioid use after breast cancer surgery

Park

Kyrish

Terrell

et al. 2019

Journal of Surgical Oncology

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Background Few guidelines exist for an opioid prescription after breast surgical oncology (BSO) procedures. We sought to characterize opioid prescribing and use patterns by surgery type. Methods Patients (n = 332) undergoing BSO procedure were surveyed one week postoperatively for opioid use. The surgeons were surveyed about pain management preferences surgery type. CPT codes were collected for 2017 to calculate the amount of opioids used by surgery type relative to surgeon preference. Results Mean oral morphine equivalent (OME) preferred prescription for surgeons who did not tailor prescriptions by surgery type (n = 7, group A) was 177, whereas for those who did tailor (n = 10, group B) varied from 137 to 257 OME. There was a significant difference in opioid use by surgery type: 32 OME for segmental mastectomy (SM) ± sentinel lymph node dissection (SLND), 63 for SM + axillary lymph node dissection (ALND), 76 for total mastectomy (TM) ± SLND, 115 for TM + ALND (P < 0.001). Considering the type of surgeries performed group A prescribers would have 229190 unused OME and group B would have 230826 in 1 year. Conclusion Wide variation in opioid use by BSO procedure type was noted with substantial unused OME regardless ofprescribing preference. Evidence‐based guidelines are needed to tailor analgesic prescriptions according to the need.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Surgeon perception versus reality: Opioid use after breast cancer surgery

Park

Kyrish

Terrell

et al. 2019

Journal of Surgical Oncology

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“…General anesthesia is associated with a higher incidence of PONV compared with regional anesthesia 35 , 52 , 53 secondary to the greater requirement for opioid medication to control postoperative pain after general anesthesia in both adults and children 35 , 54 . The performance of peripheral nerve blocks 55 – 58 , ganglion block 59 , and wound infiltration with local anesthetic 60 has been shown to decrease the incidence of PONV. Surgery-related predictors include prolonged surgical procedures, with each 30 minutes increasing the risk of PONV by 60% 36 .…”

Section: Risk Factors For Ponv and Pdnvmentioning

confidence: 99%

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

et al. 2020

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Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient’s risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery.

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“…Evidence exists supporting the role of local anesthetics for opioid reduction, decreased postoperative nausea and vomiting (PONV), decreased pain scores, decreased lengths of stay, decreased rates of certain postoperative complications, and decreased healthcare costs across a variety of plastic surgery procedures. 20 , 21 Therefore, it is imperative that the surgeon be familiar with anatomy and injection techniques and engage in a multidisciplinary approach to maximize the number of patients receiving regional anesthesia when clinically indicated. 22 Joshi et al 22 highlight that the persistent underuse of peripheral nerve blocks can be at least partially overcome by surgeon familiarity and administration of intraoperative interfascial plane blocks and appropriately performed surgical site infiltration.…”

Section: Local and Regional Analgesic Techniquesmentioning

confidence: 99%

Basics and Best Practices of Multimodal Pain Management for the Plastic Surgeon

Barker

Joshi

Janis

2020

Plastic and Reconstructive Surgery - Global Open

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Summary: Pain management is a central focus for the plastic surgeon’s perioperative planning, and it no longer represents a postoperative afterthought. Protocols that rely on opioid-only pain therapy are outdated and discouraged, as they do not achieve optimal pain relief, increase postoperative morbidity, and contribute to the growing opioid epidemic. A multimodal approach to pain management using non-opioid analgesic techniques is an integral component of enhanced recovery after surgery protocols. Careful perioperative planning for optimal pain management must be achieved in multidisciplinary collaboration with the perioperative care team including anesthesiology. This allows pain management interventions to occur at 3 critical opportunities—preoperative, intraoperative, and postoperative settings.

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Paravertebral block associated with decreased opioid use and less nausea and vomiting after reduction mammaplasty

Cited by 23 publications

References 24 publications

Surgeon perception versus reality: Opioid use after breast cancer surgery

Surgeon perception versus reality: Opioid use after breast cancer surgery

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

Basics and Best Practices of Multimodal Pain Management for the Plastic Surgeon

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