Preoperative Thoracic Paravertebral Blocks Reduce Opioid Exposure in Patients Undergoing Reduction Mammoplasty
Division of Plastic Surgery, Albert Einstein College of Medicine, USAFulltext PDF
Background: Thoracic paravertebral blocks have been shown in mastectomy to decrease pain and aid in early discharge; however, the use of this technique has not been explored in outpatient procedures such as Breast Reduction Mammoplasty (BRM). We seek to determine the effects of thoracic paravertebral blocks on pain and opioid consumption in patients undergoing BRM.
Methods: A retrospective review of all patients that underwent BRM by a single surgeon between 2016 and 2020 was conducted. Patients were divided into two cohorts: Those who received preoperative bilateral paravertebral blocks in addition to general anesthesia, and those who underwent general anesthesia alone. The primary outcome measure was opioid consumption measured in Morphine Milligram Equivalents (MME).
Results: One hundred and thirty-one patients were included for analysis (block n=58, no block n=73). Median intraoperative opioid consumption was significantly lower in patients that received paravertebral blocks as compared to controls (45.0 vs. 70.0 MME, p<0.001). On multivariable analysis, having received a paravertebral block was associated with a 19.3 MME (95% CI: 6.7-
32.0, p<0.01) reduction in intraoperative opioid dose independent of hypertensive status. In the immediate postoperative period, there was no significant difference in opioid consumption between groups, however a significantly higher proportion of patients without blocks received non-opioid analgesics for pain management as compared to those that received blocks (56.2 vs. 27.6%, p=0.001). Patient-reported pain scores did not significantly differ between groups.
Conclusion: The use of preoperative paravertebral blocks in concert with postoperative non-opioid analgesia reduces overall opioid and non-opioid analgesic exposure after BRM.
Opioid; Paravertebral; Block; Breast; Mammoplasty; BRM
Lalezar FD, Hwang LK, Greige N, Rizzo A, Ricci JA, Weichman KE. Preoperative Thoracic Paravertebral Blocks Reduce Opioid Exposure in Patients Undergoing Reduction Mammoplasty. Ann Plast Reconstr Surg. 2021;5(1):1071..