Intraoperative Local Anesthesia and Opioid Use in Enhanced Recovery After Surgery-based Breast Reduction

Opioids have traditionally been the mainstay of postoperative pain management, but their side effects and potential for dependence have prompted increased focus on opioid-sparing strategies. This study evaluates the impact of intraoperative local anesthetic techniques on postoperative opioid use and time in the postanesthesia care unit (PACU) among patients undergoing bilateral breast reduction.

A retrospective review was conducted for 199 patients who underwent bilateral breast reduction between July 2017 and December 2022 was conducted. Patients were grouped based on the intraoperative analgesic adjunct received: pectoralis nerve block I/II (n = 17), liposomal bupivacaine (n = 83), immediate-release bupivacaine (n = 62), or no local anesthetic (n = 37). The primary outcomes were opioid use in the PACU, measured in morphine milligram equivalents (MMEs), and time to discharge from the PACU, measured in minutes.

Use of anesthetic adjuncts was significantly associated with opioid consumption in PACU as compared with the control (P < 0.05). Patients who received immediate-release bupivacaine showed the lowest mean opioid use (mean = 1.96 mg MME, SD = 2.80 mg MME), whereas those with no anesthetic adjunct had the highest (mean = 4.42 mg MME, SD = 4.63 mg MME). Use of an anesthetic adjunct was not statistically associated with time in PACU.

Intraoperative local anesthetics are a valuable component of multimodal analgesia in breast reduction surgery. Immediate-release bupivacaine was shown to be associated with significantly lower opioid use in the PACU. This strategy could be considered as an adjunct in the enhanced recovery after surgery pathway for breast reduction surgery.