Improving postoperative pain management in subpectoral tissue expander implant reconstruction of the breast using an elastomeric pump

Abstract

INTRODUCTION Postoperative pain after breast surgery is one of the major factors contributing to delay in mobilisation and prolonged hospital stay. A retrospective analysis was performed of patients undergoing skin sparing mastectomy and insertion of a subpectoral implant. The aim was to determine whether the use of an elastomeric local anaesthetic pump improved pain control and length of stay. METHODS Twenty-five consecutive patients undergoing the above procedure were sited with an elastomeric local anaesthetic infusion pump intraoperatively, in addition to standard regular and pro re nata analgesia. The control group comprised 25 patients undergoing the same procedure in the same year who received standard analgesia alone. Visual analogue scale scores were recorded for the duration of inpatient stay, as was any further analgesic requirement. RESULTS The median age was 51 years (range: 26-75 years) in the intervention group and 50 years (range: 28-70 years) in the control group. The mean visual analogue scale score was 0.28 (standard deviation [SD]: 0.61) at 24 hours for the intervention group and 1.84 (SD: 0.37) for the control group (p<0.0001). The mean length of stay was 1.8 days (SD: 0.71 days) for the intervention group and 2.28 days (SD: 0.94 days) for the control group (p=0.15). There were no complications involving catheter placement, leakage or toxicity relating to use of the local anaesthetic. CONCLUSIONS There was significantly reduced pain with the use of the local anaesthetic infusion pump. The elastomeric pump is a step towards enhanced patient recovery after breast surgery in the case of skin sparing mastectomy and subpectoral tissue expander reconstruction.

Evaluating Postoperative Narcotic Use in Prepectoral Versus Dual-plane Breast Reconstruction Following Mastectomy

“… 11 The incidence of postoperative pain has increased in mastectomy patients undergoing classical reconstruction, via the subpectoral approach, with 49% experiencing acute and chronic pain. 12 – 15 Previously described methods to reduce postoperative pain include a pain-catheter, which can be cumbersome for patients and is associated with hypotension, pneumothorax, and infection. 16 Prepectoral breast reconstruction is associated with reconstructive outcomes comparable to those with dual-plane procedures.…”

Perioperative Blocks for Decreasing Postoperative Narcotics in Breast Reconstruction

“…Several studies have reported that the use of a Local Infusion Catheter (LIC) reduces reliance on postoperative narcotics (38)(39)(40)(41)(42)(43)(44)(45)(46)(47). Bupivacaine and ropivacaine are the two most commonly reported anesthetics used in LIC, and ropivacaine is frequently chosen over bupivacaine due to its lower cardiotoxic profile (22).…”

“…Bupivacaine and ropivacaine are the two most commonly reported anesthetics used in LIC, and ropivacaine is frequently chosen over bupivacaine due to its lower cardiotoxic profile (22). The LIC has been recently reported in implant-based reconstruction (40,48). Specifically, Strazisat et al reported 9.8 mg of opioid piritramide during the first 24 hours in the group that received LIC in the breast pocket, compared to 29.4 in patients who did not receive LIC.…”

Latest Trends in Subpectoral Breast Reconstruction

“…18 Chaudhry et al used a portable pain pump catheter which was placed within the breast pocket and delivered bupivacaine. 19 The pain pump was removed prior to discharge and results revealed a statistically significant reduction in pain scores in addition to reduced hospital length of stay. Liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, Inc.) has been approved for use in breast reconstruction and has shown positive results in alleviating postoperative pain control.…”