Pecs Blocks As An Adjunct To Multimodal Anesthesia For The Reduction Of Post-operative Pain And Nausea In Patients Undergoing Reduction Mammaplasty
Heather A. McMahon, MD, Sarah N. Spangler, MA, Harrison M. Lands, BA, Ashley M. Shilling, MD, D Aric Elmer, MD, Chris A. Campbell, MD.
University of Virginia, Charlottesville, VA, USA.
PURPOSE: In 2017, the American Society of Plastic Surgeons reported that 103,098 breast reductions were performed, with 15 % requiring an inpatient stay. PECS I and II blocks are safe regional blocks without significant comorbidity risk and have previously shown efficacy in patient's undergoing breast reconstruction. However, their utility in patient's undergoing reduction mammaplasty has not been investigated. This study evaluated the effect of administering PECS I and II blocks to patients undergoing reduction mammaplasty to determine the impact on opioid consumption and post-operative nausea and vomiting.
METHODS: A retrospective analysis of consecutive patients undergoing elective reduction mammaplasty from 2016-2018 were included. Total surgical time, ASA rating, and patient demographics were compared to determine group equivalence. Primary outcome measures were 24-hour morphine equivalence (ME), post-operative nausea and vomiting (PONV), and intra-operative ME.
RESULTS: 163 patients were included, with 53 receiving post-induction PECS I and II blocks and 110 receiving general anesthesia alone. ASA rating, demographics, and co-morbidities were evaluated and did not differ significantly between groups. Total surgical time was equivalent between the groups. For the control group, 24-hour ME mean was 20.0 and median was 17.5, which were significantly greater than the mean of 14.6 and median of 10.0 in the PECS Block Group (p=0.027). There were no significant differences in mean 24 hour pain scores (PECS Block 5.3 vs Control 4.8) or intra-operative ME (4.3 PECS Block vs 3.9 Control) between the groups. Incidence of PONV differed significantly between groups with a rate of 1.8% in the PECS group vs 25.6% in the control group (p <0.001). There were no procedural complications associated with block administration.
CONCLUSION: PECS I and II blocks are well tolerated and safe and resulted in a significant decrease in 24-hour ME and PONV when administered to patients undergoing reduction mammaplasty. As part of an early recovery protocol, PECS blocks would contribute towards improved care, decreased opioid use, and decrease length of stay with the potential to increase the proportion of outpatient reduction mammaplasty procedures.
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