Paravertebral Blocks Reduce Narcotic Use Without Affecting Perfusion in Patients Undergoing Autologous Breast Reconstruction
Background Autologous breast reconstruction offers excellent long term outcomes after mastectomy. However, maintaining adequate postoperative analgesia remains challenging. Use of paravertebral blocks (PVBs) reduces postoperative narcotic use and length of stay, and enhanced recovery protocols with...
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| Veröffentlicht in: | Annals of surgical oncology 2017-10, Vol.24 (11), p.3180-3187 |
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| creator | Odom, Elizabeth B. Mehta, Nili Parikh, Rajiv P. Guffey, Ryan Myckatyn, Terence M. |
| description | Background
Autologous breast reconstruction offers excellent long term outcomes after mastectomy. However, maintaining adequate postoperative analgesia remains challenging. Use of paravertebral blocks (PVBs) reduces postoperative narcotic use and length of stay, and enhanced recovery protocols with mixed analgesia methods are gaining popularity, but few studies have explored the intraoperative effects of these interventions.
Methods
Patients who underwent abdominally based autologous breast reconstruction between 2010 and 2016 were compiled into a retrospective database. We used electronic medical records to determine demographics, as well as perioperative and intraoperative vital signs and narcotic, anxiolytic, crystalloid, colloid, blood product, and vasopressor requirements, and postoperative complications. Results were compared between patients who had a PVB and those who did not and those who had a PVB alone and those who followed our enhanced recovery protocol using standard statistical methods and adjusting for preoperative values.
Results
A total of 170 patients were included in the study. Sixty-six had a PVB, and 104 did not. Of the 66 who had a PVB, 19 followed our enhanced recovery protocol. Patients who did not have a PVB required 171.6 mg of total narcotic medication in the perioperative period, those with a PVB alone required 146.9 mg, and those who followed the ERAS protocol 95.2 mg (
p
= 0.01). There was no difference in intraoperative mean arterial pressure, time with mean arterial pressure |
| doi_str_mv | 10.1245/s10434-017-6007-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6136427</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1921130120</sourcerecordid><originalsourceid>FETCH-LOGICAL-c470t-c4d3d8755c7e737b8bf7713e7c179b433203be4967f8e84aa3c8b6013f7941c23</originalsourceid><addsrcrecordid>eNp1kV1rFDEYhYMotq7-AG8k4I03o_maSeZG2Ba_oOgiLl6GTOadaeps0uajYPHHm2VrqYI3Scj75OQcDkLPKXlNmWjfJEoEFw2hsukIkc3NA3RM23ojOkUf1jPpVNOzrj1CT1K6IBXkpH2MjpiSVBHeHaNfGxPNNcQMQzQLPlmC_ZHwVxiLBfzZRBuys3ibAH93-TyUjNfTBDY7P-MNxKkkFzx2Hm9MduBzwls_QpzDHliXHJYwh5LwSQSTchW2waccS1UI_il6NJklwbPbfYW27999O_3YnH358Ol0fdZYIUmu68hHJdvWSpBcDmqYpKQcpKWyHwTnjPABRN_JSYESxnCrho5QPsleUMv4Cr096F6WYQejrT5rWH0Z3c7EnzoYp_-eeHeu53CtO8o7wWQVeHUrEMNVgZT1ziULy2I81HSa9oxSTmg1skIv_0EvQom-xquUYi1jQuwd0QNlY0gpwnRnhhK971YfutW1Mr3vVt_UNy_up7h78afMCrADkOrIzxDvff1f1d-T77Ir</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1982522442</pqid></control><display><type>article</type><title>Paravertebral Blocks Reduce Narcotic Use Without Affecting Perfusion in Patients Undergoing Autologous Breast Reconstruction</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Odom, Elizabeth B. ; Mehta, Nili ; Parikh, Rajiv P. ; Guffey, Ryan ; Myckatyn, Terence M.</creator><creatorcontrib>Odom, Elizabeth B. ; Mehta, Nili ; Parikh, Rajiv P. ; Guffey, Ryan ; Myckatyn, Terence M.</creatorcontrib><description>Background
Autologous breast reconstruction offers excellent long term outcomes after mastectomy. However, maintaining adequate postoperative analgesia remains challenging. Use of paravertebral blocks (PVBs) reduces postoperative narcotic use and length of stay, and enhanced recovery protocols with mixed analgesia methods are gaining popularity, but few studies have explored the intraoperative effects of these interventions.
Methods
Patients who underwent abdominally based autologous breast reconstruction between 2010 and 2016 were compiled into a retrospective database. We used electronic medical records to determine demographics, as well as perioperative and intraoperative vital signs and narcotic, anxiolytic, crystalloid, colloid, blood product, and vasopressor requirements, and postoperative complications. Results were compared between patients who had a PVB and those who did not and those who had a PVB alone and those who followed our enhanced recovery protocol using standard statistical methods and adjusting for preoperative values.
Results
A total of 170 patients were included in the study. Sixty-six had a PVB, and 104 did not. Of the 66 who had a PVB, 19 followed our enhanced recovery protocol. Patients who did not have a PVB required 171.6 mg of total narcotic medication in the perioperative period, those with a PVB alone required 146.9 mg, and those who followed the ERAS protocol 95.2 mg (
p
= 0.01). There was no difference in intraoperative mean arterial pressure, time with mean arterial pressure <80% of baseline, vasopressor use, or fluid requirement. There was no difference in complication rate.
Conclusions
PVBs and an enhanced recovery protocol reduce the use of narcotic medications in autologous breast reconstruction without impacting intraoperative hemodynamics. Breast reconstruction after mastectomy restores body image and improves health-related quality of life, satisfaction with appearance and physical, psychosocial, and sexual well-being (Donovan et al. in J Clin Oncol 7(7):959–968,
1989
; Eltahir et al. in Plast Reconstr Surg 132(2):201e–209e,
2013
; Jagsi et al. in Ann Surg 261(6):1198–1206,
2015
). For patients pursuing breast reconstruction, there are two major options: prosthetic (tissue expander/implant) or autologous reconstruction. However, while providing exceptional long-term outcomes, postoperative pain and length of hospital stay remains a major challenge preventing more widespread adoption of autologous breast reconstruction (Albornoz et al. in Plast Reconstr Surg 131(1):15–23,
2013
; Gurunluoglu et al. in Ann Plast Surg 70(1):103–110,
2013
; Kulkarni et al. in Plast Reconstr Surg 132(3):534–541,
2013
; Sbitany et al. in Plast Reconstr Surg 124(6):1781–1789,
2009
). Acute postoperative pain contributes to prolonged hospital stays, increased narcotic use, and associated risks of the aforementioned.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-017-6007-z</identifier><identifier>PMID: 28718036</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Breast Neoplasms - surgery ; Female ; Follow-Up Studies ; Humans ; Mammaplasty - adverse effects ; Mastectomy - adverse effects ; Medicine ; Medicine & Public Health ; Middle Aged ; Narcotics - therapeutic use ; Nerve Block - methods ; Oncology ; Pain Management - methods ; Pain, Postoperative - etiology ; Pain, Postoperative - prevention & control ; Perfusion ; Prognosis ; Quality of Life ; Reconstructive Oncology ; Retrospective Studies ; Surgery ; Surgical Oncology ; Tissue Expansion Devices</subject><ispartof>Annals of surgical oncology, 2017-10, Vol.24 (11), p.3180-3187</ispartof><rights>Society of Surgical Oncology 2017</rights><rights>Annals of Surgical Oncology is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-c4d3d8755c7e737b8bf7713e7c179b433203be4967f8e84aa3c8b6013f7941c23</citedby><cites>FETCH-LOGICAL-c470t-c4d3d8755c7e737b8bf7713e7c179b433203be4967f8e84aa3c8b6013f7941c23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-017-6007-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-017-6007-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28718036$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Odom, Elizabeth B.</creatorcontrib><creatorcontrib>Mehta, Nili</creatorcontrib><creatorcontrib>Parikh, Rajiv P.</creatorcontrib><creatorcontrib>Guffey, Ryan</creatorcontrib><creatorcontrib>Myckatyn, Terence M.</creatorcontrib><title>Paravertebral Blocks Reduce Narcotic Use Without Affecting Perfusion in Patients Undergoing Autologous Breast Reconstruction</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
Autologous breast reconstruction offers excellent long term outcomes after mastectomy. However, maintaining adequate postoperative analgesia remains challenging. Use of paravertebral blocks (PVBs) reduces postoperative narcotic use and length of stay, and enhanced recovery protocols with mixed analgesia methods are gaining popularity, but few studies have explored the intraoperative effects of these interventions.
Methods
Patients who underwent abdominally based autologous breast reconstruction between 2010 and 2016 were compiled into a retrospective database. We used electronic medical records to determine demographics, as well as perioperative and intraoperative vital signs and narcotic, anxiolytic, crystalloid, colloid, blood product, and vasopressor requirements, and postoperative complications. Results were compared between patients who had a PVB and those who did not and those who had a PVB alone and those who followed our enhanced recovery protocol using standard statistical methods and adjusting for preoperative values.
Results
A total of 170 patients were included in the study. Sixty-six had a PVB, and 104 did not. Of the 66 who had a PVB, 19 followed our enhanced recovery protocol. Patients who did not have a PVB required 171.6 mg of total narcotic medication in the perioperative period, those with a PVB alone required 146.9 mg, and those who followed the ERAS protocol 95.2 mg (
p
= 0.01). There was no difference in intraoperative mean arterial pressure, time with mean arterial pressure <80% of baseline, vasopressor use, or fluid requirement. There was no difference in complication rate.
Conclusions
PVBs and an enhanced recovery protocol reduce the use of narcotic medications in autologous breast reconstruction without impacting intraoperative hemodynamics. Breast reconstruction after mastectomy restores body image and improves health-related quality of life, satisfaction with appearance and physical, psychosocial, and sexual well-being (Donovan et al. in J Clin Oncol 7(7):959–968,
1989
; Eltahir et al. in Plast Reconstr Surg 132(2):201e–209e,
2013
; Jagsi et al. in Ann Surg 261(6):1198–1206,
2015
). For patients pursuing breast reconstruction, there are two major options: prosthetic (tissue expander/implant) or autologous reconstruction. However, while providing exceptional long-term outcomes, postoperative pain and length of hospital stay remains a major challenge preventing more widespread adoption of autologous breast reconstruction (Albornoz et al. in Plast Reconstr Surg 131(1):15–23,
2013
; Gurunluoglu et al. in Ann Plast Surg 70(1):103–110,
2013
; Kulkarni et al. in Plast Reconstr Surg 132(3):534–541,
2013
; Sbitany et al. in Plast Reconstr Surg 124(6):1781–1789,
2009
). Acute postoperative pain contributes to prolonged hospital stays, increased narcotic use, and associated risks of the aforementioned.</description><subject>Breast Neoplasms - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Mammaplasty - adverse effects</subject><subject>Mastectomy - adverse effects</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Narcotics - therapeutic use</subject><subject>Nerve Block - methods</subject><subject>Oncology</subject><subject>Pain Management - methods</subject><subject>Pain, Postoperative - etiology</subject><subject>Pain, Postoperative - prevention & control</subject><subject>Perfusion</subject><subject>Prognosis</subject><subject>Quality of Life</subject><subject>Reconstructive Oncology</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Tissue Expansion Devices</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kV1rFDEYhYMotq7-AG8k4I03o_maSeZG2Ba_oOgiLl6GTOadaeps0uajYPHHm2VrqYI3Scj75OQcDkLPKXlNmWjfJEoEFw2hsukIkc3NA3RM23ojOkUf1jPpVNOzrj1CT1K6IBXkpH2MjpiSVBHeHaNfGxPNNcQMQzQLPlmC_ZHwVxiLBfzZRBuys3ibAH93-TyUjNfTBDY7P-MNxKkkFzx2Hm9MduBzwls_QpzDHliXHJYwh5LwSQSTchW2waccS1UI_il6NJklwbPbfYW27999O_3YnH358Ol0fdZYIUmu68hHJdvWSpBcDmqYpKQcpKWyHwTnjPABRN_JSYESxnCrho5QPsleUMv4Cr096F6WYQejrT5rWH0Z3c7EnzoYp_-eeHeu53CtO8o7wWQVeHUrEMNVgZT1ziULy2I81HSa9oxSTmg1skIv_0EvQom-xquUYi1jQuwd0QNlY0gpwnRnhhK971YfutW1Mr3vVt_UNy_up7h78afMCrADkOrIzxDvff1f1d-T77Ir</recordid><startdate>20171001</startdate><enddate>20171001</enddate><creator>Odom, Elizabeth B.</creator><creator>Mehta, Nili</creator><creator>Parikh, Rajiv P.</creator><creator>Guffey, Ryan</creator><creator>Myckatyn, Terence M.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20171001</creationdate><title>Paravertebral Blocks Reduce Narcotic Use Without Affecting Perfusion in Patients Undergoing Autologous Breast Reconstruction</title><author>Odom, Elizabeth B. ; Mehta, Nili ; Parikh, Rajiv P. ; Guffey, Ryan ; Myckatyn, Terence M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-c4d3d8755c7e737b8bf7713e7c179b433203be4967f8e84aa3c8b6013f7941c23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Breast Neoplasms - surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Mammaplasty - adverse effects</topic><topic>Mastectomy - adverse effects</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Narcotics - therapeutic use</topic><topic>Nerve Block - methods</topic><topic>Oncology</topic><topic>Pain Management - methods</topic><topic>Pain, Postoperative - etiology</topic><topic>Pain, Postoperative - prevention & control</topic><topic>Perfusion</topic><topic>Prognosis</topic><topic>Quality of Life</topic><topic>Reconstructive Oncology</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Tissue Expansion Devices</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Odom, Elizabeth B.</creatorcontrib><creatorcontrib>Mehta, Nili</creatorcontrib><creatorcontrib>Parikh, Rajiv P.</creatorcontrib><creatorcontrib>Guffey, Ryan</creatorcontrib><creatorcontrib>Myckatyn, Terence M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Odom, Elizabeth B.</au><au>Mehta, Nili</au><au>Parikh, Rajiv P.</au><au>Guffey, Ryan</au><au>Myckatyn, Terence M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Paravertebral Blocks Reduce Narcotic Use Without Affecting Perfusion in Patients Undergoing Autologous Breast Reconstruction</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2017-10-01</date><risdate>2017</risdate><volume>24</volume><issue>11</issue><spage>3180</spage><epage>3187</epage><pages>3180-3187</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
Autologous breast reconstruction offers excellent long term outcomes after mastectomy. However, maintaining adequate postoperative analgesia remains challenging. Use of paravertebral blocks (PVBs) reduces postoperative narcotic use and length of stay, and enhanced recovery protocols with mixed analgesia methods are gaining popularity, but few studies have explored the intraoperative effects of these interventions.
Methods
Patients who underwent abdominally based autologous breast reconstruction between 2010 and 2016 were compiled into a retrospective database. We used electronic medical records to determine demographics, as well as perioperative and intraoperative vital signs and narcotic, anxiolytic, crystalloid, colloid, blood product, and vasopressor requirements, and postoperative complications. Results were compared between patients who had a PVB and those who did not and those who had a PVB alone and those who followed our enhanced recovery protocol using standard statistical methods and adjusting for preoperative values.
Results
A total of 170 patients were included in the study. Sixty-six had a PVB, and 104 did not. Of the 66 who had a PVB, 19 followed our enhanced recovery protocol. Patients who did not have a PVB required 171.6 mg of total narcotic medication in the perioperative period, those with a PVB alone required 146.9 mg, and those who followed the ERAS protocol 95.2 mg (
p
= 0.01). There was no difference in intraoperative mean arterial pressure, time with mean arterial pressure <80% of baseline, vasopressor use, or fluid requirement. There was no difference in complication rate.
Conclusions
PVBs and an enhanced recovery protocol reduce the use of narcotic medications in autologous breast reconstruction without impacting intraoperative hemodynamics. Breast reconstruction after mastectomy restores body image and improves health-related quality of life, satisfaction with appearance and physical, psychosocial, and sexual well-being (Donovan et al. in J Clin Oncol 7(7):959–968,
1989
; Eltahir et al. in Plast Reconstr Surg 132(2):201e–209e,
2013
; Jagsi et al. in Ann Surg 261(6):1198–1206,
2015
). For patients pursuing breast reconstruction, there are two major options: prosthetic (tissue expander/implant) or autologous reconstruction. However, while providing exceptional long-term outcomes, postoperative pain and length of hospital stay remains a major challenge preventing more widespread adoption of autologous breast reconstruction (Albornoz et al. in Plast Reconstr Surg 131(1):15–23,
2013
; Gurunluoglu et al. in Ann Plast Surg 70(1):103–110,
2013
; Kulkarni et al. in Plast Reconstr Surg 132(3):534–541,
2013
; Sbitany et al. in Plast Reconstr Surg 124(6):1781–1789,
2009
). Acute postoperative pain contributes to prolonged hospital stays, increased narcotic use, and associated risks of the aforementioned.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>28718036</pmid><doi>10.1245/s10434-017-6007-z</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2017-10, Vol.24 (11), p.3180-3187 |
| issn | 1068-9265 1534-4681 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6136427 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Breast Neoplasms - surgery Female Follow-Up Studies Humans Mammaplasty - adverse effects Mastectomy - adverse effects Medicine Medicine & Public Health Middle Aged Narcotics - therapeutic use Nerve Block - methods Oncology Pain Management - methods Pain, Postoperative - etiology Pain, Postoperative - prevention & control Perfusion Prognosis Quality of Life Reconstructive Oncology Retrospective Studies Surgery Surgical Oncology Tissue Expansion Devices |
| title | Paravertebral Blocks Reduce Narcotic Use Without Affecting Perfusion in Patients Undergoing Autologous Breast Reconstruction |
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