Association of Peripheral Nerve Block Use and Increased Wound Complications in Breast Reconstruction

Peripheral nerve block (PNB) use in breast reconstruction (BR) improves postoperative pain with minimal risks. This study examines outcomes of patients receiving PNB for postoperative analgesia in BR.

A retrospective analysis using the American College of Surgeons National Surgical Quality Improvement Program database identified women who underwent BR from 2012 to 2021. Patients who received regional anesthesia in addition to general anesthesia were included, and those who received other forms of anesthesia were excluded. Postoperative complications were compared between PNB and non-PNB groups, as well as among BR timing, modality, operative time, and American Society of Anesthesiologists classification. Group differences were assessed using t tests and Fisher exact tests. Multivariate logistic regression assessed whether complications were independently associated with receiving PNBs.

Of the 25,188 patients, 9429 patients (37.4%) received PNBs for perioperative BR analgesia. Patients who received PNBs had longer operative times and more wound complications, reoperations, and readmissions. PNB use was associated with an increased likelihood of surgical site infection even when BR modality, timing, operative time, and American Society of Anesthesiologists classification were isolated ( P < 0.05). Further, subgroup analysis revealed that PNB use was associated with surgical site infection for all BR modalities and timing.

The decision to use PNBs in BR should be made with awareness of the associated risk of increased wound complications. Despite this, benefits of PNBs may still very well outweigh these risks for all our patients. However, based on our findings, we still suggest increased surveillance and more comprehensive consultation. Further research into the association of PNB use and wound complications should be performed so that our patients can obtain maximal benefit and minimize unwanted side effects.