Paravertebral Blocks Reduce Narcotic Use Without Affecting Perfusion in Patients Undergoing Autologous Breast Reconstruction

Abstract

Background: Autologous breast reconstruction offers excellent long term outcomes after mastectomy. However maintaining adequate post-operative analgesia remains challenging. Use of paravertebral blocks (PVBs) reduces postoperative narcotic use and length of stay, and enhanced recovery protocols with mixed analgesia methods are gaining popularity, but few studies have explored the intraoperative effects of these interventions. Methods: Patients who underwent abdominally-based autologous breast reconstruction between 2010 and 2016 were compiled into a retrospective database. We used electronic medical records to determine demographics as well as perioperative and intraoperative vital signs and narcotic, anxiolytic, crystalloid, colloid, blood product, and vasopressor requirements, and postoperative complications. Results were compared between patients who had a PVB and those who did not, and those who had a PVB alone and those who followed our enhanced recovery protocol using standard statistical methods and adjusting for preoperative values. Results: 170 patients were included in the study. Sixty-six had a PVB, and 104 did not. Of the 66 who had a PVB, 19 followed our enhanced recovery protocol. Patients who did not have a PVB required 171.6mg of total narcotic medication in the perioperative period, those with a PVB alone required 146.9mg, and those who followed the ERAS protocol 95.2mg (p=0.01). There was no difference in intraoperative mean arterial pressure, time with mean arterial pressure <80% of baseline, vasopressor use, or fluid requirement. There was no difference in complication rate. Conclusions: PVBs and an enhanced recovery protocol reduce the use of narcotic medications in autologous breast reconstruction without impacting intraoperative hemodynamics.

Enhanced Recovery With Paravertebral and Transversus Abdominis Plane Blocks in Microvascular Breast Reconstruction

“…They also have the advantage of not affecting intraoperative blood pressure. 15 It is our opinion that ERAS in microvascular breast reconstruction should be the standard of care. Our study is consistent with a recent meta-analysis that found significant improvement in opioid use and length of stay with no increase in complications.…”

Enhanced Recovery After Surgery for Breast Reconstruction: Pooled Meta-Analysis of 10 Observational Studies Involving 1,838 Patients

“…All studies employed in this review used better practices of venous thromboembolism prophylaxis, preoperative and intraoperative analgesia, perioperative intravenous fluid management, postoperative analgesia, postoperative flap monitoring, and early mobilization, but only Batdorf et al (8) reported the practice of a standard anesthetic protocol. Surprisingly, ERAS elements were implemented in conventional programs by Kaoutzanis et al (5), Afonso et al (6), Batdorf et al (8), and Odom et al (23), which weakens the impact of an ERAS/FTS program to a certain extent. Undeniably, the result was not robust owing to the small number of studies included.…”

Breast implant‐associated anaplastic large cell lymphoma (BIA‐ALCL): an overview of presentation and pathogenesis and guidelines for pathological diagnosis and management

“…However, despite the association between BIA‐ALCL and Ralstonia spp. this does not prove causation, and it has been suggested that this may simply reflect an opportunistic infection . A significantly greater risk has been identified in association with implants with the roughest textured surface compared to those with less prominent texturing .…”