Does surgical procedure type impact postoperative pain and recovery in deep inferior epigastric artery perforator flap breast reconstruction?

Abstract

Background The deep inferior epigastric artery perforator (DIEP) flap is the commonest flap used for breast reconstruction after mastectomy. It is performed as a unilateral (based on one [unipedicled] or two [bipedicled] vascular pedicles) or bilateral procedure following unilateral or bilateral mastectomies. No previous studies have comprehensively analyzed analgesia requirements and hospital stay of these three forms of surgical reconstruction.Methods A 7-year retrospective cohort study (2008–2015) of a single-surgeon’s DIEP-patients was conducted. Patient-reported pain scores, patient-controlled morphine requirements and recovery times were compared using non-parametric statistics and multivariable regression.Results The study included 135 participants: unilateral unipedicled (n=84), unilateral bipedicled (n=24) and bilateral unipedicled (n=27). Univariate comparison of the three DIEP types showed a significant difference in 12-hour postoperative morphine requirements (P=0.020); bipedicled unilateral patients used significantly less morphine than unipedicled (unilateral) patients at 12 (P=0.005), 24 (P=0.020), and 48 (P=0.046) hours. Multivariable regression comparing these two groups revealed that both reconstruction type and smoking status were significant predictors for 12-hour postoperative morphine usage (P=0.038 and P=0.049, respectively), but only smoking, remained significant at 24 (P=0.010) and 48 (P=0.010) hours. Bilateral reconstruction patients’ mean hospital stay was 2 days longer than either unilateral reconstruction (P<0.001).Conclusions Although all three forms of DIEP flap breast reconstruction had similar postoperative pain measures, a novel finding of our study was that bipedicled DIEP flap harvest might be associated with lower early postoperative morphine requirements. Bilateral and bipedicled procedures in appropriate patients might therefore be undertaken without significantly increased pain/morbidity compared to unilateral unipedicled reconstructions.

Clinical outcomes following robotic versus conventional DIEP flap in breast reconstruction: A retrospective matched study

“…The amount of fentanyl mixed in the PCA device was significantly lower in the robotic DIEP group (851 ± 195 µg) than in the conventional DIEP group (1051 ± 490 µg) (P=0.003). However, the morphine equivalent dose of fentanyl mixed with PCA in the conventional DIEP group was higher than that in previous studies ( 25 , 26 ), which may be the reason why there was not much of a difference in NRS scores, despite the statistically significant differences in the dose of fentanyl. Furthermore, the fentanyl amounts in the PACU and other rescue analgesics in the admission room were comparable between the two groups, while a significant difference in the number of patients receiving tridol during the 6-24 h postoperative period was noted.…”

Factors influencing postoperative abdominal pain in DIEP flap breast reconstruction

“…However, the effect of bilateral harvesting of vascular pedicles on postoperative pain remains unclear because performing surgery on both breasts can also be associated with increased postoperative pain. According to a recent study by Azizi et al, morphine usage was significantly lower in a bipedicled DIEP flap group than in a unipedicled DIEP flap group in patients undergoing unilateral breast reconstruction (17). In their multivariate analysis, bipedicled reconstruction was still an independent predictor of lower immediate postoperative morphine requirements.…”