Association of Regional Anesthesia With Reduced Post-discharge Opioid Prescriptions Following Immediate Autologous...

Postoperative pain may be significant following mastectomy and immediate autologous breast reconstruction, and pain management regimens must be balanced with opioid stewardship. Regional anesthesia has been associated with reduced opioid consumption in smaller studies and may represent a promising method of acute pain management. This study evaluates rates of opioid prescription and renewal following immediate autologous reconstruction depending on receipt of regional anesthesia.

All adult female patients who underwent immediate autologous breast reconstruction in the 2024 National Surgical Quality Improvement Program dataset were identified. Patient cohorts who did and did not receive regional anesthesia were propensity score-matched in a 1:2 ratio. Rates of post-discharge opioid prescriptions and subsequent renewals were compared between cohorts (P < .05).

The final cohort included 1103 patients. Regional anesthesia was utilized in 231 (20.9%) cases, and the rate of post-discharge opioid prescription was 60.8% (671 patients). After matching on covariates like body mass index, operative time, and local anesthesia utilization (n = 684), regional anesthesia usage was associated with significantly lower rates of opioid prescriptions (57.0% vs. 66.4%; P = .020) and conferred lower odds of opioid prescription in multivariable analysis (OR: 0.71, 95% CI: 0.51-0.99; P = .041). Among patients who were prescribed opioids, the rate of renewal was similar between matched cohorts (6.6% vs. 6.2%; P = 1.00).

Regional anesthesia was associated with reduced post-discharge opioid prescriptions and similar rates of prescription renewal following immediate autologous breast reconstruction. These findings support the further investigation and possible integration of regional anesthesia within pain management regimens for autologous breast reconstruction.