Regional Anesthesia as Primary Strategy in Aesthetic Breast Augmentation Surgery: Clinical Outcomes in 627 Sedated...

Post-operative pain after breast augmentation remains unpredictable, and regional anesthesia alone is seldom described. We evaluated an opioid-free protocol combining pectoral nerves (PECS I-II) and parasternal blocks with intravenous sedation.

Between January 2020 and December 2024, 627 women (mean age 35 y) underwent bilateral primary augmentation under ultrasound-guided fascial-plane blocks plus sedation. VAS pain scores were recorded at predefined intervals up to 72 h. Descriptive statistics, cubic modelling of pain trajectories and Kruskal-Wallis tests compared implant planes; cumulative pain was expressed as the 0-72 h area under the curve (AUC).

Mean VAS was < 2 in all groups by 72 h. Pain peaked at 16 h, highest with dual-plane placement (mean 7.0) and lower with submuscular and pre-pectoral placements (both ≈ 5.5; p < 0.001). Inter-group differences persisted to 48 h but disappeared by 72 h (p = 0.115). AUC confirmed the greatest pain burden for dual-plane (292 VAS·h) versus submuscular (238) and pre-pectoral (200). Implant volume showed only a weak overall correlation with pain (ρ = 0.20) and none within individual planes. No patient required rescue opioids; most resumed normal activities within four days, and no major complications occurred.

Ultrasound-guided PECS I-II and parasternal blocks with sedation provide safe, effective, opioid-free analgesia for aesthetic breast augmentation. Early pain is determined mainly by the implant plane, not by implant size, and should be considered in surgical planning and postoperative care.

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