Nerve Blocks in Breast Plastic Surgery: Outcomes, Complications, and Comparative Efficacy

Abstract

Background: As plastic surgeons continue to evaluate the utility of nonopioid analgesic alternatives, nerve block use in breast plastic surgery remains limited and unstandardized, with no syntheses of the available evidence to guide consensus on optimal approach. Methods: A systematic review was performed to evaluate the role of pectoralis nerve blocks, paravertebral nerve blocks, transversus abdominus plane blocks, and intercostal nerve blocks in flap-based breast reconstruction, prosthetic-based reconstruction, and aesthetic breast plastic surgery, independently. Results: Thirty-one articles reporting on a total of 2820 patients were included in the final analysis; 1500 patients (53 percent) received nerve blocks, and 1320 (47 percent) served as controls. Outcomes and complications were stratified according to procedures performed, blocks employed, techniques of administration, and anesthetic agents used. Overall, statistically significant reductions in opioid consumption were reported in 91 percent of studies evaluated, postoperative pain in 68 percent, postanesthesia care unit stay in 67 percent, postoperative nausea and vomiting in 53 percent, and duration of hospitalization in 50 percent. Nerve blocks did not significantly alter surgery and/or anesthesia time in 83 percent of studies assessed, whereas the overall, pooled complication rate was 1.6 percent. Conclusions: Transversus abdominus plane blocks provided excellent outcomes in autologous breast reconstruction, whereas both paravertebral nerve blocks and pectoralis nerve blocks demonstrated notable efficacy and versatility in an array of reconstructive and aesthetic procedures. Ultrasound guidance may minimize block-related complications, whereas the efficacy of adjunctive postoperative infusions was proven to be limited. As newer anesthetic agents and adjuvants continue to emerge, nerve blocks are set to represent essential components of the multimodal analgesic approach in breast plastic surgery.

Artificial Intelligence in Plastic Surgery: Insights from Plastic Surgeons, Education Integration, ChatGPT’s Survey Predictions, and the Path Forward

“…32 In plastic surgery, ChatGPT has found applications in systematic reviews, virtual consultations, preoperative planning, and patient education. 33–36 Our study demonstrated ChatGPT’s ability to provide a broad qualitative prediction with approximately 91% accuracy in survey questions, showcasing its potential to analyze extensive datasets and offer insightful predictions. However, challenges exist, and ChatGPT lacks medical specialization, which can lead to inaccuracies and ethical concerns.…”

Emerging Longer-Acting Local Anesthetic Formulations for Plastic Surgeons

“…With the backdrop of a deteriorating opioid epidemic, multimodal intraoperative and postoperative analgesia represent an imperative practice for plastic surgeons to adopt. 1 , 2 Nerve blocks have come to represent an essential component in a plastic surgeon's armamentarium for reducing postoperative pain through direct and predictable inhibition of peripheral nociceptive signaling. 1 Indeed, our group has previously reported on significant reductions in postoperative opioid consumption, postoperative pain, PACU stay, nausea and vomiting, and duration of hospitalization associated with nerve block use in breast plastic surgery.…”

“… 1 Indeed, our group has previously reported on significant reductions in postoperative opioid consumption, postoperative pain, PACU stay, nausea and vomiting, and duration of hospitalization associated with nerve block use in breast plastic surgery. 2 …”

“…Liposomal bupivacaine, an anesthetic formulation in which bupivacaine is encapsulated by multivesicular liposomes, has been reported to promise 96 hours of sustained anesthetic release. 2 Motakef et al have demonstrated superior efficacy of liposomal bupivacaine relative to bupivacaine alone in blocks targeting supraclavicular and intercostal nerves in breast surgery, whereas a randomized control trial by Gatherwright et al demonstrated superior efficacy of liposomal bupivacaine relative to bupivacaine when used in transversus abdominis plane (TAP) blocks. 3 , 4 Despite being associated with a significantly greater cost ($315 USD per 366 mg per 20-mL vial, vs $5.24 USD per 75-mL vial of bupivacaine), cost minimalization analyses have demonstrated that reductions in length of stay, hospital costs, and 30-day admission rates may contribute to more favorable economic profiles associated with liposomal bupivacaine use.…”

Local Infiltration Anesthesia Versus Ultrasound-Guided Pectoralis (PEC1) + Serratus Anterior Plane (SAP) Blocks on Postanesthetic Care Unit Pain Control in Patients Undergoing Primary Submuscular Augmentation Mammoplasty

“…7,8 A recent systematic review of nerve blocks in plastic surgery has shown favorable outcomes. 9 Of the known truncal regional blocks, PEC 1 and SAP are the least studied, and currently there is no medical evidence which demonstrates their superiority over blind local infiltration anesthesia in plastic surgery. This study aimed to compare the outcomes of surgeon-led, ultrasound-guided PEC1 + SAP blocks against local infiltration anesthesia in patients undergoing submuscular augmentation mammoplasty in an outpatient surgery center.…”