Practical Review of Abdominal and Breast Regional Analgesia for Plastic Surgeons: Evidence and Techniques

Abstract

Summary: Regional analgesia has been increasing in popularity due to its opioid- sparing analgesic effects and utility in multimodal analgesia strategies. Several regional techniques have been used in plastic surgery; however, there is a lack of consensus on the indications and the comparative efficacy of these blocks. The goal of this review is to provide evidence-based recommendations on the most relevant types of interfascial plane blocks for abdominal and breast surgery. A systematic search of the PUBMED, EMBASE, and Cochrane databases was performed to identify the evidence associated with the different interfascial plane blocks used in plastic surgery. The search included all studies from inception to March 2020. A total of 126 studies were included and used in the synthesis of the information presented in this review. There is strong evidence for using the transversus abdominis plane blocks in both abdominoplasties as well as abdominally-based microvascular breast reconstruction as evidenced by a significant reduction in post-operative pain and opioid consumption. Pectoralis (I and II), serratus anterior, and erector spinae plane blocks all provide good pain control in breast surgeries. Finally, the serratus anterior plane block can be used as primary block or an adjunct to the pectoralis blocks for a wider analgesia coverage of the breast. All the reviewed blocks are safe and easy to administer. Interfascial plane blocks are effective and safe modalities used to reduce pain and opioid consumption after abdominal and breast plastic surgery.

Multimodal Analgesia in the Aesthetic Plastic Surgery: Concepts and Strategies

“…[115][116][117][118] The PECS II block is performed by injecting 10-20 cm 3 of local anesthetic between the pectoralis minor and serratus anterior muscle at the level of the third rib to blunt intercostal nerves 3-6 and the long thoracic PRS Global Open • 2022 nerves. [115][116][117][118] The PECS blocks are traditionally performed under ultrasound guidance but can also be performed under direct visualization intraoperatively. The erector spinae plane block is performed under ultrasound guidance by injecting 20 cm 3 of local anesthetic between the rhomboid major and erector spinae muscle; this provides anesthesia from the T2 to T9 level from the midclavicular line to 3 cm lateral of midline from the thoracic spine.…”

Applications of Ultrasound in the Postoperative Period: A Review

“…63 64 65 Depending on the operative procedure and type of block being utilized, the block is administered either in the immediate preoperative setting by the anesthesiologist or intraoperatively by an experienced plastic surgeon. 66 This allows for the block to have a strong perioperative and postoperative analgesic effect. Numerous studies have demonstrated the efficacy of these blocks in reducing postoperative pain, opioid consumption, and length of hospital stay.…”

Regional Anaesthesia in Enhanced Recovery After Surgery Pathways – A Quintessential Component

“…[37,38] ESPB at various levels have been successfully employed and provided opioid-sparing analgesia after spine surgeries also. [39,40] RA techniques like pectoral nerve blocks (PECS 1/2), thoracic PVB, thoracic ESPB, serratus anterior plane block (SAPB) have been established as excellent, opioid-sparing interventions as a part of MMA for breast surgeries which have been attested by several RCTs and review articles. [41][42][43][44][45][46] Not only do RA techniques provide opioid-sparing analgesia, reduced incidence of PONV, the propensity of post-mastectomy pain is also reduced if acute post-surgical pain is managed effectively.…”