Thoracic Intercostal Nerve Blocks Reduce Opioid Consumption and Length of Stay in Patients Undergoing Implant-Based Breast Reconstruction

Shah, Ajul; Rowlands, Megan; Krishnan, Naveen M.; Patel, Anup; Ott-Young, Anke

doi:10.1097/prs.0000000000001717

Cited by 40 publications

(46 citation statements)

References 27 publications

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“…10,11,13 However, whereas all previous published studies regarding the role of PVB in breast reconstruction have only included patients undergoing prosthetic (implant/expander) reconstruction, this study expands our current understanding of the benefits of PVB to patients undergoing autologous breast reconstruction. This is an important distinction as there is an evolving body of literature that demonstrates autologous tissue reconstruction, compared to prosthetic (tissue expander/implant) reconstruction, is a cost-effective strategy in the long-term and is associated with improved patient-reported quality of life and satisfaction with cosmetic outcomes for patients pursuing postmastectomy breast reconstruction.…”

Section: Discussionmentioning

confidence: 91%

Preoperative Paravertebral Block Improves Postoperative Pain Control and Reduces Hospital Length of Stay in Patients Undergoing Autologous Breast Reconstruction after Mastectomy for Breast Cancer

et al. 2016

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Purpose Postoperative pain is a major challenge for patients undergoing breast reconstruction after surgical treatment of breast cancer, resulting in prolonged hospitalizations and additional resource utilization. Evidence on the efficacy of techniques to minimize postoperative pain in autologous breast reconstruction is lacking. The purpose of this study is to determine if preoperative paravertebral block, a regional anesthetic technique, impacts postoperative pain control and length of stay in patients undergoing autologous breast reconstruction. Methods Consecutive patients undergoing postmastectomy autologous breast reconstruction between 2012 and 2015 were identified from a prospectively-collected database to compare those who received PVB to those who did not. Primary outcomes included self-reported pain score, time to oral-only narcotic usage (TTON), and hospital length of stay (LOS). Sample differences were compared using Wilcoxon rank-sum and Chi-squared for continuous and categorical variables. Kaplan-Meier analysis was used to evaluate TTON and LOS, with Mantel-Cox test used to compare groups. Results Of 78 patients, 39 received PVB and 39 did not. Study groups did not differ regarding age, BMI, ASA class, mastectomy type, flap type, or cancer stage (p>0.05). Patients in the PVB group reported significantly lower postoperative pain at 2 (p<0.01) and 24 hours (p<0.01) and shorter median TTON (66 vs. 76 hours, p<0.01). Importantly, median LOS was reduced for patients receiving a PVB in both hours (95 vs. 116, p<0.01) and hospital nights (4 vs. 5, p=0.05). Conclusions Preoperative PVB is associated with improved postoperative pain control and shorter hospitalizations for patients with breast cancer undergoing postmastectomy autologous reconstruction.

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Section: Discussionmentioning

confidence: 91%

Preoperative Paravertebral Block Improves Postoperative Pain Control and Reduces Hospital Length of Stay in Patients Undergoing Autologous Breast Reconstruction after Mastectomy for Breast Cancer

et al. 2016

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“…CNB, by using local anesthetics, allows the patient to avoid the adverse effects of opioid analgesics, such as nausea, vomiting, drowsiness, constipation, and respiratory depression. [11] By blocking the conduction channel of pain, CNB decreases central and peripheral sensitization and thus reduces the risk of postoperative chronic pain. [12] With the use of low concentrations of local anesthetics for postoperative analgesia, it is possible to selectively block the sensory nerve fibers; preservation of motor function promotes early functional rehabilitation [13] and decreases the risk of deep venous thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided continuous femoral nerve block vs continuous fascia iliaca compartment block for hip replacement in the elderly

Yu¹,

He²,

Cai³

et al. 2016

Medicine

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Background:Continuous femoral nerve block and fascia iliaca compartment block are 2 traditional anesthesia methods in orthopedic surgeries, but it is controversial which method is better. The objective of this study was to compare the practicality, efficacy, and complications of the 2 modalities in hip replacement surgery in the elderly and to assess the utility of a novel cannula-over-needle set.Methods:In this prospective, randomized controlled clinical investigation, 60 elderly patients undergoing hip replacement were randomly assigned to receive either continuous femoral nerve block or continuous fascia iliaca compartment block. After ultrasound-guided nerve block, all patients received general anesthesia for surgery and postoperative analgesia through an indwelling cannula. Single-factor analysis of variance was used to compare the outcome variables between the 2 groups.Results:There was a significant difference between the 2 groups in the mean visual analog scale scores (at rest) at 6 hours after surgery: 1.0 ± 1.3 in the femoral nerve block group vs 0.5 ± 0.8 in the fascia iliaca compartment block group (P < 0.05). The femoral nerve block group had better postoperative analgesia on the medial aspect of the thigh, whereas the fascia iliaca compartment block group had better analgesia on the lateral aspect of the thigh. There were no other significant differences between the groups.Conclusions:Both ultrasound-guided continuous femoral nerve block and fascia iliaca compartment block with the novel cannula-over-needle provide effective anesthesia and postoperative analgesia for elderly hip replacement patients.

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“…Preoperative injection of the surgical incision site with local anesthetic has been shown to decrease opioid requirements in breast reduction. 53,54 Numerous regional anesthetic blocks have shown to decrease opioid requirements: transversus abdominis plane block in autologous breast reconstruction 55–57 ; thoracic intercostal nerve block in implant-based reconstruction 58 ; epidural anesthesia in belt lipectomy 59 ; and a combination of intercostal, ilioinguinal, iliohypogastric, and pararectus blocks in abdominoplasty. 60 Postoperative infusion of local anesthetic into the surgical site, either intermittently or continuously through use of a pump, has also been shown to reduce opioid requirements in breast reduction 61 and autologous breast reconstruction.…”

Section: Recommendationsmentioning

confidence: 99%

Managing Opioid Addiction Risk in Plastic Surgery during the Perioperative Period

Demsey

Carr

Clarke

et al. 2017

Plastic &Amp; Reconstructive Surgery

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Summary Opioid addiction is a public health crisis that affects all areas of medicine. Large numbers of the population across all racial and economic demographics misuse prescription opioids and use illicit opioids. The current understanding is that opioid misuse is a disease that requires treatment, and is not an issue of choice or character. Use of opioid medication is a necessary part of postoperative analgesia, but many physicians are unsure of how to do this safely given the risk of patients developing an opioid misuse disorder. This review gives an update of the current state of the opioid crisis, explains how current surgeons prescribing practices are contributing to it, and gives recommendations on how to use opioid medication safely in the perioperative period.

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Thoracic Intercostal Nerve Blocks Reduce Opioid Consumption and Length of Stay in Patients Undergoing Implant-Based Breast Reconstruction

Abstract: Therapeutic, III.

Cited by 40 publications

References 27 publications

Preoperative Paravertebral Block Improves Postoperative Pain Control and Reduces Hospital Length of Stay in Patients Undergoing Autologous Breast Reconstruction after Mastectomy for Breast Cancer

Preoperative Paravertebral Block Improves Postoperative Pain Control and Reduces Hospital Length of Stay in Patients Undergoing Autologous Breast Reconstruction after Mastectomy for Breast Cancer

Ultrasound-guided continuous femoral nerve block vs continuous fascia iliaca compartment block for hip replacement in the elderly

Managing Opioid Addiction Risk in Plastic Surgery during the Perioperative Period

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