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Nerve Blocks in Breast Plastic Surgery: Outcomes, Complications, and Comparative Efficacy
Jad Abi-Rafeh1, Tyler Safran1, Joanne Abi-Jaoude1
1From the Faculty of Medicine, McGill University; and Division of Plastic and Reconstructive Surgery, McGill University Health Center.
Plastic and Reconstructive Surgery
|May 2, 2022
Summary
Nerve blocks significantly reduce opioid use and pain in breast plastic surgery. Pectoralis and paravertebral blocks are versatile, while TAP blocks excel in autologous reconstruction, improving patient outcomes.
Area of Science:
- Plastic Surgery
- Anesthesiology
- Pain Management
Background:
- Nerve block utilization in breast plastic surgery is limited and lacks standardization.
- There is a need for evidence synthesis to guide optimal nerve block approaches.
Purpose of the Study:
- To systematically review the evidence on various nerve blocks in breast plastic surgery.
- To evaluate their role in reconstructive and aesthetic procedures.
Main Methods:
- Systematic review of 31 articles involving 2820 patients.
- Analysis of pectoralis, paravertebral, transversus abdominus plane (TAP), and intercostal nerve blocks.
- Outcomes stratified by procedure, block type, administration, and anesthetic agents.
Main Results:
- 91% of studies showed reduced opioid consumption; 68% reported less postoperative pain.
- Nerve blocks decreased PACU stay (67%) and hospitalization duration (50%).
- Pooled complication rate was low at 1.6%; surgery/anesthesia time was unaffected in 83% of studies.
Conclusions:
- TAP blocks are effective for autologous reconstruction; paravertebral and pectoralis blocks show broad efficacy.
- Ultrasound guidance may reduce complications; adjunctive infusions had limited efficacy.
- Nerve blocks are crucial for multimodal analgesia in breast plastic surgery.
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