The efficacy of ultrasound-guided erector spinae plane block after mastectomy and immediate breast reconstruction with a tissue expander: a randomized clinical trial

Purpose: Two-stage tissue expander (TE) to implant breast reconstruction is commonly performed by plastic surgeons. Prepectoral implant placement with acellular dermal matrix (ADM, e.g., AlloDerm®) reinforcement is evidenced by minimal postoperative pain. However, the same is not known for TE-based reconstruction. We performed this study to explore the use of complete AlloDerm® reinforcement of breast pocket tissues in women undergoing unilateral or bilateral mastectomies followed by immediate, two-stage tissue expansion in the prepectoral plane.Methods: Patients (n = 20) aged 18-75 years were followed prospectively from their preoperative consult to 60 days post-TE insertion. The pain visual analog scale (VAS), Patient Pain Assessment Questionnaire, Subjective Pain Survey, Brief Pain Inventory-Short Form (BPI-SF), postoperative nausea and vomiting (PONV) survey, BREAST-Q Reconstruction Module, and short-form 36 (SF-36) questionnaires were administered. Demographic, intraoperative, and 30-and 60-day complications data were abstracted from medical records. After TE-to-implant exchange, patients were followed until 60 days postoperatively to assess for complications.Results: Pain VAS and BPI-SF pain interference scores returned to preoperative values by 30 days post-TE insertion. Static and moving pain scores from the Patient Pain Assessment Questionnaire returned to preoperative baseline values by day 60. The mean subjective pain score was 3.0 (0.5 standard deviation) with seven patients scoring outside the standard deviation; none of these seven patients had a history of anxiety or depression. Median PONV scores remained at 0 from postoperative day 0 to day 7. Patient-reported opioid use dropped from 89.5% to 10.5% by postoperative day 30. BREAST-Q: Sexual well-being scores significantly increased from preoperative baseline to day 60 post-TE insertion. Changes in SF-36 physical functioning, physician limitations, emotional well-being, social functioning, and pain scores were significantly different from preoperative baseline to day 60 post-TE insertion. Five participants had complications within 60 days post-TE insertion. One participant experienced a complication within 60 days after TE-to-implant exchange.Conclusions: We describe pain scores, opioid usage, patient-reported outcomes data, and complication profiles of 20 consecutive patients undergoing mastectomy followed by immediate, two-stage tissue expansion in the prepectoral plane. We hope this study serves as a baseline for future research.

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“…were higher than our study potentially due to differential utilization of preoperative anti-emetics [20,21].…”

Section: Discussioncontrasting

confidence: 78%

The Use of Alloderm® Coverage to Reinforce Tissues in Two-Stage Tissue Expansion Placement in the Subcutaneous (Prepectoral) Plane: A Prospective Pilot Study

Tiongco¹,

Puthumana²,

Khan³

et al. 2022

Cureus

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“…As aforementioned, there were 11 studies (680 subjects) discussing the use of ESPB in breast surgery. 24–26 , 31 , 36 , 38 , 39 , 47 , 48 , 54 , 64 The results showed that patients received ESPB were associated with a significant reduction of postoperative morphine consumption during the first 24 h after surgery (−7.01 mg, 95% CI −9.16 to −4.85; p<0.001) ( Figure 3 ), but with a high heterogeneity (I 2 = 96%).…”

Section: Resultsmentioning

confidence: 99%

“…Out of the 52 RCTs, 11 were about breast surgeries, 24–26 , 31 , 36 , 38 , 39 , 47 , 48 , 54 , 64 15 were about orthopedic surgeries, 10 , 11 , 21–23 , 27 , 28 , 32 , 33 , 50 , 52 , 53 , 56 , 57 , 60 5 were about thoracoscopic surgeries, 12 , 25 , 34 , 58 , 59 6 were about cholecystectomy, 29 , 30 , 41 , 45 , 63 , 65 6 were about nephrolithotomy, 37 , 44 , 49 , 61 , 62 , 68 2 were about cardiac surgeries, 14 , 42 and 7 were others. 40 , 43 , 46 , 51 , 55 , 66 , 67 The characteristics of enrolled 52 studies were listed in the Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…For postoperative analgesics, 20 studies used morphine, 11 , 21 , 27 , 31 , 32 , 35 , 36 , 40 , 43–45 , 47 , 48 , 50 , 54 , 55 , 60 , 64 , 65 , 68 11 studies used fentanyl, 14 , 38 , 41 , 42 , 46 , 51 , 56–59 , 62 9 studies used tramadol, 23 , 28–30 , 37 , 39 , 49 , 53 , 63 5 studies used sufentanil, 12 , 22 , 24–26 4 studies used pethidine, 33 , 34 , 66 , 67 2 studies used oxycodone 10 , 52 and 1 study used nalbuphine. 61 However, the heterogeneity did not reduce by the subgroup analysis ( Figure 5 ).…”

Section: Resultsmentioning

confidence: 99%

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The Effect of Single-Shot Erector Spinae Plane Block (ESPB) on Opioid Consumption for Various Surgeries: A Meta-Analysis of Randomized Controlled Trials

Cui¹,

Wang²,

Yang³

et al. 2022

JPR

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Study Objective Pain management plays a pivotal role in enhanced recovery after surgery (ERAS). Erector spinae plane block (ESPB) is widely used in many regions to treat perioperative pain, but its benefits are still somewhat controversial. We, therefore, intent to systematically review the available literature on ESPB, to elucidate its effects on opioid-sparing analgesia, and summarize its potential complications. Design Systematic review of randomized controlled trials (RCTs) with meta-analysis. Setting Postoperative opioid consumption for various surgeries. Patients Patients undergoing various surgeries. Intervention We searched relevant studies in PubMed, EMBASE, Medline, and the Cochrane Library up to May 16, 2021. All prospective and RCTs that compared ESPB and sham block or no block were enrolled. Measurements The primary outcomes were postoperative opioid consumption during the first 24 hours. The secondary outcomes were the requirement of rescue analgesia, time to first rescue analgesic and ESPB-related adverse events. Results We included 52 trials that reported postoperative opioid consumption during the first 24 hours. The results presented that compared to control group (ie, no intervention or a sham block), ESPB reduced the accumulated opioid consumption during the first 24 h after surgery [mean difference (MD) of − 12.83 (95% CI: − 17.29 to − 8.38; p < 0.001) mg; I 2 = 100%]. Besides, ESPB could prolong time to first rescue analgesia after surgery [SMD = 5.31; 95% CI 4.01–6.61; p < 0.001; I 2 = 97%]. The number of patients who received rescue analgesia after surgery in the ESPB group was less than that in the control group (OR 0.13; 95% CI 0.09, 0.21; p < 0.001; I 2 = 54%), and the incidence of PONV was lower in the ESPB group (OR 0.51; 95% CI 0.43, 0.62; p < 0.001; I 2 = 19%). Conclusion ESPB is an effective technique on pain management with few complications.

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“…[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.…”

Section: Available Evidence Regarding Implementation Of Ra In Erasmentioning

confidence: 99%

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

Nair¹,

Diwan²

2021

IJRA

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Enhanced recovery after surgery (ERAS) is a multimodal, perioperative care pathway designed to achieve early recovery for patients undergoing major surgery. [1] Initially described by Henry Kehlet in 1995 for colonic surgeries, the enhanced recovery pathways have now evolved and are now validated for more than 30 different types of surgery which include but are not limited to emergency laparotomy, neonatal surgeries, and lower segment cesarean sections. [2] Not only is the patient benefited from this by having an enhanced recovery and early discharge from the hospital, the cost of treatment is reduced and also leads to more turnover of patients thereby reducing the waiting list of patients scheduled for various surgeries. [3]

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The efficacy of ultrasound-guided erector spinae plane block after mastectomy and immediate breast reconstruction with a tissue expander: a randomized clinical trial

Cited by 22 publications

References 42 publications

The Use of Alloderm® Coverage to Reinforce Tissues in Two-Stage Tissue Expansion Placement in the Subcutaneous (Prepectoral) Plane: A Prospective Pilot Study

The Use of Alloderm® Coverage to Reinforce Tissues in Two-Stage Tissue Expansion Placement in the Subcutaneous (Prepectoral) Plane: A Prospective Pilot Study

The Effect of Single-Shot Erector Spinae Plane Block (ESPB) on Opioid Consumption for Various Surgeries: A Meta-Analysis of Randomized Controlled Trials

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

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