Preoperative Paravertebral Block Improves Health Resource Utilization and Reduces Postoperative Pain in Patients Undergoing Autologous Breast Reconstruction after Mastectomy for Breast Cancer
Rajiv P. Parikh, MD, Ketan Sharma, MD, MPH, Ryan Guffey, MD, Terence M. Myckatyn, MD.
Washington University in St. Louis, Saint Louis, MO, USA.
PURPOSE: There is increasing evidence that preoperative paravertebral blocks (PVB) reduce postoperative pain and length of stay (LOS) for patients undergoing surgical treatment of breast cancer, including mastectomy with prosthetic reconstruction. However, evidence on the efficacy of PVB in autologous breast reconstruction is lacking. The purpose of this study is to determine if preoperative PVB impacts postoperative pain control and LOS in patients undergoing autologous breast reconstruction.
METHODS: We performed a retrospective matched case-control analysis of consecutive patients undergoing post-mastectomy autologous breast reconstruction from 2012 to 2014 comparing those who received PVB to those who did not. Primary outcomes included self-reported pain score, time to oral-only narcotic usage (TTON), and LOS. Sample differences were compared using Wilcoxon rank-sum and Chi-squared for continuous and categorical variables. Kaplan-Meier analysis was used to evaluate TTON and LOS, with Mantel-Cox test used to compare groups.
RESULTS: Of 78 patients, 39 received PVB and 39 did not. Cases and controls did not differ regarding age, BMI, ASA class, exposure to chemotherapy or radiation, mastectomy type, flap type, unilateral versus bilateral surgery, or cancer stage (p>0.05). PVB patients reported significantly lower postoperative pain at 2 and 24 hours (p<0.01) and exhibited significantly shorter median TTON (66 vs. 76 hours, p<0.01). Importantly, median LOS was significantly reduced for PVB patients in both hours (95 vs. 116, p<0.01) and hospital nights (4 vs. 5, p=0.05).
CONCLUSION: This is the first study to demonstrate that preoperative PVB significantly reduces LOS and postoperative pain in patients undergoing autologous breast reconstruction.
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