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Plastic Surgery Research Council

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Opioid Sparing Strategies In Alloplastic Breast Reconstruction: A Systematic Review
Dustin T. Crystal, BS, Ahmed MS Ibrahim, MD, PhD, Louise L. Blankensteijn, MD, Nicholas G. Cuccolo, BS, Darya Kazei, ND, Bernard T. Lee, MD, MBA, MPH, Samuel J. Lin, MD, MBA.
Beth Israel Deaconess Medical Center, Boson, MA, USA.

PURPOSE: Women experience significant pain following mastectomy. This pain is often exacerbated by breast implants or tissue expanders employed for alloplastic breast reconstruction (AlBR). Although opioids are a hallmark of post-operative pain management, their limited efficacy in AlBR, short-term complications, and long-term dependence necessitate opioid-sparing strategies.
METHODS: A systematic literature search of MEDLINE (Pubmed), Embase, Web of Science, and Cochrane Central Register was performed to identify articles related to opioid-sparing strategies in breast reconstruction. The review followed PRISMA guidelines and was registered in PROSPERO. 1184 unique articles were identified.
RESULTS: Following inclusion criteria, 13 articles were identified assessing opioid sparing strategies in AlBR. Table 1 reports the article interventions, outcomes, and bias analyses. Statistical reductions in opioid consumption and increased patient satisfaction were observed in enhanced recovery pathways (ERPs). Paravertebral blocks (PVB) reduced pain and opioid consumption. Conflicting results precludes a recommendation to implement intercostal blocks in AlBR. Despite inconsistent reductions in opioid consumption and pain scores, liposomal bupivacaine (LB) reduced hospital length of stay. Non-steroidal agents such as diclofenac reduced early post-operative opioid use, however further evidence is required to reach a consensus determination.
CONCLUSION: Several opioid-sparing strategies are described for pain management in AlBR. Reporting outcomes and study quality are variable. Multimodal analgesia can be considered via ERPs which include PVBs and LB. Additional prospective, randomized trials are necessary to delineate modality efficacy.


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