P321 Analgesia with thoracic wall nerve block for breast reconstruction with expander or implant

Hisada, Takeshi; Nakada, Junya; Okumura, Shun; Kondou, N.; Sawaki, Masataka; Yoshimura, Adriana Akemi; Adachi, Y.; Ishiguro, Junko; Kotani, H.; Iwata, Hiromitsu

doi:10.1016/s0960-9776(15)70351-6

Cited by 1 publication

(4 citation statements)

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“…In addition, there was significant variability in the regimen used, making it impossible to draw conclusions regarding optimal duration of anticoagulation. Despite this, the studies included in our review did point to a benefit of prophylactic enoxaparin in reducing venous thromboembolism without increasing the risk of hematoma formation 49,52,54,55 . These findings are in keeping with the larger VTEPS study, which examined thromboembolic events in a variety of plastic surgery procedures and concluded that postoperative, inpatient enoxaparin decreases 60-day rates of symptomatic thromboembolic events without significantly affecting hematoma rates 67 .…”

Section: Discussionsupporting

confidence: 63%

“…this, the studies included in our review did point to a benefit of prophylactic enoxaparin in reducing venous thromboembolism without increasing the risk of hematoma formation. 49,52,54,55 These findings are in keeping with the larger VTEPS study, which examined thromboembolic events in a variety of plastic surgery procedures and concluded that postoperative, inpatient enoxaparin decreases 60-day rates of symptomatic thromboembolic events without significantly affecting hematoma rates. 67 To this end, although further research should examine approaches to preventing thromboembolic events in breast reconstruction patients, the limited evidence that does exist in this patient population is supported by the wider plastic surgery literature, which recommends the use of prophylactic postoperative enoxaparin.…”

Section: Rcsupporting

confidence: 70%

“…There was consensus that nerve blocks are effective modes of pain control in breast reconstruction (Table 9). [52][53][54][55] When compared with general anesthesia alone, epidural nerve blocks combined with general anesthesia were shown to result in a reduced average pain score, but a delay in operative start time and increased vasopressor use. 52 Transverse abdominal plane block was associated with reduced LOS, opioid use, and postoperative nausea and vomiting.…”

Section: Painmentioning

confidence: 99%

“…52 Transverse abdominal plane block was associated with reduced LOS, opioid use, and postoperative nausea and vomiting. 55 Similarly, paravertebral nerve 53 and thoracic wall nerve 54 blocks decreased opioid use and incidence of nausea but increase the average time of anesthesia induction. The herbal agents Arnica montana and Bellis perennis were shown to decrease opioid intake with no difference in quality of life and postoperative pain measures.…”

Section: Painmentioning

confidence: 99%

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Systematic Review of Patient Safety and Quality Improvement Initiatives in Breast Reconstruction

Paffile¹,

McGuire

Bezuhly

2022

Ann Plast Surg

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Background: Improving patient care and safety requires high-quality evidence. The objective of this study was to systematically review the existing evidence for patient safety (PS) and quality improvement initiatives in breast reconstruction. Methods: A systematic review of the published plastic surgery literature was undertaken using a computerized search and following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Publication descriptors, methodological details, and results were extracted. Articles were assessed for methodological quality and clinical heterogeneity. Descriptive statistics were completed, and a meta-analysis was considered. Results: Forty-six studies were included. Most studies were retrospective (52.2%) and from the third level of evidence (60.9%). Overall, the scientific quality was moderate, with randomized controlled trials generally being higher quality. Studies investigating approaches to reduce seroma (28.3% of included articles) suggested a potential benefit of quilting sutures. Studies focusing on infection (26.1%) demonstrated potential benefits to prophylactic antibiotics and drain use under 21 days. Enhanced recovery after surgery protocols (10.9%) overall did not compromise PS and was beneficial in reducing opioid use and length of stay. Interventions to increase flap survival (10.9%) demonstrated a potential benefit of nitroglycerin on mastectomy skin flaps. Conclusions: Overall, studies were of moderate quality and investigated several worthwhile interventions. More validated, standardized outcome measures are required, and studies focusing on interventions to reduce thromboembolic events and bleeding risk could further improve PS.

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Section: Discussionsupporting

confidence: 63%