Postoperative pain and opioid use after breast reduction with or without preoperative nerve block

LaFontaine, Samantha; Yao, Amy; Hwang, Lyahn K.; Draper, Lawrence B.; Benacquista, Teresa; Garfein, Evan S.; Weichman, Katie E.

doi:10.1016/j.bjps.2021.11.089

Cited by 5 publications

(10 citation statements)

References 21 publications

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“…26,27 One prospective study did not demonstrate decreased pain scores or reduction in opioid consumption for 5 postoperative days. 26 In an RCT comparing ESP and tumescent, ESP blocks demonstrated significantly lower pain scores and analgesia requirements and higher patient satisfaction. 27 As regional block selection is largely dependent on anesthesiologist ability and preference, a discussion should occur between the surgeon and the anesthesiologist before surgery regarding the extent of work to be done and in which anatomic region(s), as this may alter block choice.…”

Section: Discussionmentioning

confidence: 97%

“…However, a study noted significantly longer anesthesia time in the group who underwent the block, 24 a similar finding in this study, in which the PECS II block group had longer procedural time and overall longer time in the operating room. There have been 2 studies published investigating ESP in reduction mammaplasty 26,27 . One prospective study did not demonstrate decreased pain scores or reduction in opioid consumption for 5 postoperative days 26 .…”

Section: Discussionmentioning

confidence: 99%

“…There have been 2 studies published investigating ESP in reduction mammaplasty 26,27 . One prospective study did not demonstrate decreased pain scores or reduction in opioid consumption for 5 postoperative days 26 . In an RCT comparing ESP and tumescent, ESP blocks demonstrated significantly lower pain scores and analgesia requirements and higher patient satisfaction 27 …”

Section: Discussionmentioning

confidence: 99%

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Comparison of Tumescent Anesthesia Versus Pectoral Nerve Block in Bilateral Reduction Mammaplasty

et al. 2023

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Introduction With an increasing focus on multimodal pain control to reduce opioid requirements, regional and local anesthesia techniques have been investigated in bilateral reduction mammaplasty with variable results. The purpose of this study is to compare tumescent anesthesia with pectoral nerve block II (PECS II) in patients undergoing bilateral reduction mammaplasty with respect to postoperative pain and nausea, opioid consumption, length of stay, and cost. Methods A retrospective review of patients undergoing bilateral reduction mammaplasty for macromastia between November 2020 and December 2021 was performed. Demographic information, operative and anesthesia times, antiemetic and morphine equivalent requirements, postoperative numeric pain rating scales, and time until hospital discharge were compared between groups. χ 2 and Fisher exact tests examined subgroup differences in categorical variables. Two-sample t test and Wilcoxon rank-sum test evaluated differences in continuous parametric and nonparametric variables, respectively. Results Fifty-three patients underwent bilateral reduction mammaplasty by 3 surgeons, 71.7% (n = 38) with tumescent anesthesia infiltrated by the operating surgeon before the start of the procedure and 28.3% (n = 15) with bilateral PECS II blocks performed by anesthesia before the start of the procedure. There was no difference in age, body mass index, weight resected, intraoperative medication, or immediate postoperative complications. Postoperative pain scores and opioid requirements were similar between the 2 groups. Twenty-one percent (n = 8) of tumescent patients compared with 66.7% (n = 10) of block patients required 1 or more doses of postoperative antiemetics (P = 0.002). Patients who received blocks spent longer in the postoperative recovery area (5.3 vs 7.1 hours, P < 0.01). However, this did not translate to a significant increase in overnight stays. The block group had significantly higher hospitalization cost by an average of $4000, driven by pharmacy and procedural cost (P < 0.01). Conclusion In this cohort of multimodal perioperative pain-controlled reduction mammaplasty patients, tumescent anesthesia was associated with decreased antiemetic requirements, less time in recovery before discharge, and lower cost compared with PECS II blocks. Therefore, tumescent anesthesia may be favored over PECS II blocks when considering multimodal pain control strategies in reduction mammaplasty patients.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison of Tumescent Anesthesia Versus Pectoral Nerve Block in Bilateral Reduction Mammaplasty

et al. 2023

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“…This study was designed to characterize the prescribing patterns of plastic surgery residents and therefore did not include a quantification of opioid consumption by patients after breast reduction, which has been previously described. [22][23][24] As recommended by the Centers for Disease Control and Prevention, opioid prescriptions at discharge were converted into morphine milligram equivalents (MME) using a standardized conversion formula 25 : total MME = dosage Â doses prescribed Â MME conversion factor. Because of New York State restrictions, the state opioid prescribing database could not be accessed retrospectively to identify all concomitant opioid prescriptions in the patients studied.…”

Section: Methodsmentioning

confidence: 99%

Variability in Opioid Prescribing Among Plastic Surgery Residents After Bilateral Breast Reduction

Fiscella,

Awad,

Shihadeh

et al. 2023

Ann Plast Surg

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Background Prescription opioid misuse in the United States accounts for significant avoidable morbidity and mortality. Over one third of all prescriptions written by surgeons are for opioids. Although opioids continue to provide needed analgesia for surgical patients, there are few guidelines in the plastic surgery literature for their safe and appropriate use after surgery. The consequence is wide variability and excessive opioid prescriptions. Understanding patterns of prescribing among plastic surgery residents is a crucial step toward developing safer practice models for managing postoperative pain. Methods The authors performed a retrospective analysis of discharge opioid prescriptions after bilateral breast reduction at a single academic medical center from 2018 to 2021. Single factor 1-way analysis of variance was used to evaluate prescribing patterns by resident, postgraduate year, attending of record, and patient characteristics for 126 patients. A multivariate analysis was performed to determine the degree to which these factors predicted opioid prescriptions. Results This analysis revealed significant variability among residents prescribing opioids after bilateral breast reductions (P < 0.001) irrespective of patient comorbidities and demographics. Residents were found to be the main predictor of opioid prescriptions after surgery (P < 0.001) with a greater number of morphine milligram equivalents prescribed by the more junior residents (P < 0.001). Conclusions Excessive and variable opioid prescriptions among plastic surgery residents highlight the need for opioid prescribing education early in surgical training and improved oversight and communication with attending surgeons. Furthermore, implementation of evidence-based opioid-conscious analgesic protocols after common surgical procedures may improve patient safety by standardizing postoperative analgesic prescriptions.

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“…The study on tau protein shows that opioids can affect cognitive function through JNK/p38 MAPK participating in the phosphorylation of tau upstream. The current concept of multimodal analgesia and the extensive development of ultrasound-guided nerve block (Mayr et al, 2007;Elvir-Lazo and White, 2010;LaFontaine et al, 2022) may effectively reduce the use of opioids during the perioperative period and improve cognitive function.…”

Section: Opioidsmentioning

confidence: 99%

Tau protein plays a role in the mechanism of cognitive disorders induced by anesthetic drugs

Chen

Wang²,

ZhaoQian³

et al. 2023

Front. Neurosci.

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Cognitive disorders are mental health disorders that can affect cognitive ability. Surgery and anesthesia have been proposed to increase the incidence of cognitive dysfunction, including declines in memory, learning, attention and executive function. Tau protein is a microtubule-associated protein located in the axons of neurons and is important for microtubule assembly and stability; its biological function is mainly regulated by phosphorylation. Phosphorylated tau protein has been associated with cognitive dysfunction mediated by disrupting the stability of the microtubule structure. There is an increasing consensus that anesthetic drugs can cause cognitive impairment. Herein, we reviewed the latest literature and compared the relationship between tau protein and cognitive impairment caused by different anesthetics. Our results substantiated that tau protein phosphorylation is essential in cognitive dysfunction caused by anesthetic drugs, and the possible mechanism can be summarized as “anesthetic drugs-kinase/phosphatase-p-Tau-cognitive impairment”.

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Postoperative pain and opioid use after breast reduction with or without preoperative nerve block

Cited by 5 publications

References 21 publications

Comparison of Tumescent Anesthesia Versus Pectoral Nerve Block in Bilateral Reduction Mammaplasty

Comparison of Tumescent Anesthesia Versus Pectoral Nerve Block in Bilateral Reduction Mammaplasty

Variability in Opioid Prescribing Among Plastic Surgery Residents After Bilateral Breast Reduction

Tau protein plays a role in the mechanism of cognitive disorders induced by anesthetic drugs

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