Intraoperative Intercostal Nerve Block for Postoperative Pain Control in Pre-Pectoral versus Subpectoral Direct-To-Implant Breast Reconstruction: A Retrospective Study

Abstract

<jats:p>Background and Objectives: Patients undergoing mastectomy and implant-based breast reconstruction have significant acute postsurgical pain. The purpose of this study was to examine the efficacy of intercostal nerve blocks (ICNBs) for reducing pain after direct-to-implant (DTI) breast reconstruction. Materials and Methods: Between January 2019 and March 2020, patients who underwent immediate DTI breast reconstruction were included in this study. The patients were divided into the ICNB or control group. In the ICNB group, 4 cc of 0.2% ropivacaine was injected intraoperatively to the second, third, fourth, and fifth intercostal spaces just before implant insertion. The daily average and maximum visual analogue scale (VAS) scores were recorded by the patient from operative day to postoperative day (POD) seven. Pain scores were compared between the ICNB and control groups and analyzed according to the insertion plane of implants. Results: A total of 67 patients with a mean age of 47.9 years were included; 31 patients received ICNBs and 36 patients did not receive ICNBs. There were no complications related to ICNBs reported. The ICNB group showed a significantly lower median with an average VAS score on the operative day (4 versus 6, p = 0.047), lower maximum VAS scores on the operative day (5 versus 7.5, p = 0.030), and POD 1 (4 versus 6, p = 0.030) as compared with the control group. Among patients who underwent subpectoral reconstruction, the ICNB group showed a significantly lower median with an average VAS score on the operative day (4 versus 7, p = 0.005), lower maximum VAS scores on the operative day (4.5 versus 8, p = 0.004), and POD 1 (4 versus 6, p = 0.009), whereas no significant differences were observed among those who underwent pre-pectoral reconstruction. Conclusions: Intraoperative ICNBs can effectively reduce immediate postoperative pain in subpectoral DTI breast reconstruction; however, it may not be effective in pre-pectoral DTI reconstruction.</jats:p>

Intraoperative Interpectoral and Subserratus Nerve Blocks in Breast Augmentation Surgery

“…In addition, in subpectoral reconstruction, damage to the periosteum from dissection of the subpectoral space, hemostasis, and direct compression from the implant can cause significant pain. 33 Many blocks are described in the literature; however, there remains discordance regarding the best approach to deliver regional anesthesia. Traditionally, the gold standard amongst regional anesthesia has been paravertebral blocks (PVBs) and thoracic spinal epidural, which provide dense blockade of the neural supply to the thoracic wall.…”

“…In addition, in subpectoral reconstruction, damage to the periosteum from dissection of the subpectoral space, hemostasis, and direct compression from the implant can cause significant pain. 33 …”

<p>The Effect of Low and High Vacuum Drainage on the Postoperative Drainage of Breast Cancer: Insights from a Prospective, Non-Inferiority, Randomized Clinical Trial</p>

“…The drain was removed when the drainage amount was less than 30 mL per day for 2 consecutive days. 18 The secondary outcome measures included total amount of aspirate after operation, cost of negative suction bottles, and postoperative pain score. The daily amount of each drainage was calculated at 7 a.m. every day after the operation.…”

“…The drain was removed when the drainage amount was less than 30 mL per day for 2 consecutive days. 18 …”