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Opioid-sparing Strategies in Alloplastic Breast Reconstruction: A Systematic Review.
Dustin T Crystal1, Ahmed M S Ibrahim2, Louise L Blankensteijn2
1Division of Plastic Surgery, Hospital of the University of Pennsylvania, Perlman School of Medicine, Philadelphia, Pa.
Plastic and Reconstructive Surgery. Global Open
|November 19, 2021
Summary
Opioid-sparing pain management after alloplastic breast reconstruction (AlBR) can be achieved through enhanced recovery protocols (ERAS), paravertebral blocks, and liposomal bupivacaine. These strategies reduce opioid use and improve patient outcomes.
Area of Science:
- Plastic Surgery
- Pain Management
- Oncology
Background:
- Post-mastectomy pain is common in alloplastic breast reconstruction (AlBR).
- Opioids are often used but have limited efficacy and significant risks.
- Effective opioid-sparing strategies are needed for AlBR pain management.
Purpose of the Study:
- To systematically review opioid-sparing pain management strategies in alloplastic breast reconstruction (AlBR).
Main Methods:
- Systematic literature search of major databases (MEDLINE, Embase, Web of Science, Cochrane).
- Inclusion criteria: patients 18+ undergoing AlBR.
- PRISMA guidelines followed; 1184 articles identified, 14 included.
Main Results:
- Enhanced recovery after surgery (ERAS) pathways, paravertebral blocks, and liposomal bupivacaine showed reduced opioid utilization.
- Included studies comprised five randomized trials and nine cohort studies.
- Significant heterogeneity in study characteristics and outcomes was observed.
Conclusions:
- Multimodal analgesia via ERAS pathways is recommended for AlBR pain.
- Paravertebral blocks and liposomal bupivacaine field blocks are beneficial opioid-sparing components of ERAS.
- Further randomized trials are needed to confirm efficacy of other modalities.
