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Paravertebral and erector spinae plane blocks decrease length of stay compared with local infiltration analgesia in
Haripriya S Ayyala1, Melissa Assel2, Joseph Aloise3
1Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
Regional Anesthesia and Pain Medicine
|February 9, 2024
Summary
Replacing local infiltration with paravertebral (PVB) or erector spinae plane (ESP) blocks significantly reduces postoperative length of stay for breast reconstruction patients. Both blocks offer comparable benefits, with ESP emerging as a viable alternative to PVB.
Area of Science:
- Anesthesiology
- Plastic Surgery
- Oncology
Background:
- Autologous breast reconstruction often involves significant pain, delaying patient recovery.
- Current pain management relies on surgeon-administered local infiltration.
- Novel regional anesthesia techniques may improve outcomes.
Purpose of the Study:
- To evaluate the impact of preoperative paravertebral (PVB) and erector spinae plane (ESP) blocks as alternatives to local infiltration.
- To assess the effect of these blocks on pain management and recovery after latissimus dorsi myocutaneous flap breast reconstruction.
Main Methods:
- Retrospective cohort study of 122 patients undergoing mastectomy with latissimus flap reconstruction (2018-2022).
- Patients were categorized into three groups: local infiltration, PVB block, and ESP block.
- Analysis focused on postoperative length of stay (LOS), pain, opioid consumption, and antiemetic use.
Main Results:
- PVB block was associated with a 20-hour shorter postoperative LOS (p<0.001).
- ESP block was associated with a 24-hour shorter postoperative LOS (p<0.001).
- Both PVB and ESP blocks significantly reduced intraoperative opioid consumption (p<0.001).
Conclusions:
- Replacing local infiltration with PVB or ESP blocks effectively reduces length of stay in autologous breast reconstruction.
- ESP block presents a viable alternative to PVB for latissimus flap breast reconstruction.
- Further research is warranted to compare patient outcomes between ESP and PVB in complex breast reconstruction.
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