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Alghamdi M, Alsayed B, Albenmousa F, Salleh SB, Alqaysi L, Alfayez J, Mandoorah J, Alanzi R, Alshayeqe G, Albaqmi S, Sabi A, Arif S, Mortada H. Local Anesthetic Infiltration for Pain Control in Aesthetic Breast Reduction Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Aesthetic Plast Surg 2024:10.1007/s00266-024-04249-x. [PMID: 38977458 DOI: 10.1007/s00266-024-04249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Aesthetic breast surgeries, including breast reduction, are commonly performed surgical procedures associated with postoperative pain. Pain control is essential to patient comfort, satisfaction, and early recovery. This systematic review is the first to conduct both qualitative and quantitative analysis to evaluate the efficacy and safety of local anesthetic infiltration in reducing pain after breast reduction surgeries. METHODS This systematic review is registered in PROSPERO, assessed for bias using the RoB2 tool, and follows the PRISMA guidelines. A full electronic search was performed in different databases for all clinical papers on adult female patients undergoing cosmetic breast reduction surgery who were given local anesthetic infiltration for postoperative pain relief. RESULTS A systematic review of five randomized clinical trials with a total of 191 patients found that local anesthetic infiltration significantly reduces postoperative pain in breast reduction surgery, reduces opioid consumption, and improves patient outcomes. A meta-analysis of two trials reported the mean VAS score for postoperative pain in the local anesthetic and placebo groups. CONCLUSION A systematic review and a meta-analysis show a significant reduction in postoperative pain following local anesthetic infiltration, but further research is needed to understand its effectiveness and potential adverse effects. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Maysaa Alghamdi
- College of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
| | - Bader Alsayed
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | | | - Sumayyah Bin Salleh
- College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Luba Alqaysi
- College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Joud Alfayez
- College of Pharmacy, Qassim University, Buraydah, Saudi Arabia
| | - Joana Mandoorah
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Reem Alanzi
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ghina Alshayeqe
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Sara Albaqmi
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ahmed Sabi
- College of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Sultan Arif
- Department of Plastic Surgery and Burn Unit, Security Force Hospital, Riyadh, Saudi Arabia
| | - Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Plastic Surgery and Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
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Cho J, Kim KH, Lee W, Go JY, Kim SH. Effectiveness of a Novel Temperature-Responsive Hydrogel (PF72) for Postoperative Pain Relief in Breast Augmentation. J Clin Med 2023; 13:110. [PMID: 38202117 PMCID: PMC10779951 DOI: 10.3390/jcm13010110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/09/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Breast augmentation can cause severe postoperative pain, leading to an increased length of hospital stay. Postoperative pain management following breast surgery has traditionally involved intravenous and oral analgesics. However, the misuse of opioids can cause severe complications. As a result, several alternative methods have been suggested. Fifty patients were included in this study. All the patients underwent dual-plane pocket dissection using the transaxillary approach and received smooth-type breast implants. The intervention group included 25 patients who received PF72 combined with ropivacaine, and the control group included 25 patients who received only bupivacaine. The Numerical Rating Scale (NRS) score was used to evaluate each patient's pain. Three hours after the surgery, the average NRS scores of the control and intervention groups were 3.75 and 2.48, respectively. Six hours after the operation, the NRS scores of the control and intervention groups increased to 4.77 and 3.02, respectively. PF72 combined with ropivacaine was more effective than only bupivacaine for pain control in patients who underwent breast augmentations.
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Affiliation(s)
- Jeongmok Cho
- Department of Plastic and Reconstructive Surgery, Etonne Plastic Surgery Clinic, Seoul 06531, Republic of Korea;
| | - Ki Hyun Kim
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea;
| | - Won Lee
- Department of Plastic and Reconstructive Surgery, Yonsei E1 Plastic Surgery Clinic, Anyang 14046, Republic of Korea;
| | - Ju Young Go
- Department of Plastic and Reconstructive Surgery, Atelier Plastic Surgery Clinic, Seoul 06584, Republic of Korea;
| | - Seong Hwan Kim
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea;
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Yang H, Wang H, Wang Q. The analgesic efficacy of pectoral nerve block for breast augmentation: a meta-analysis of randomized controlled studies. J Plast Surg Hand Surg 2023; 58:142-148. [PMID: 38095482 DOI: 10.2340/jphs.v58.9395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/18/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Many patients suffered from serious pain after breast augmentation, but the analgesic efficacy of pectoral nerve block for these patients was not well established. Thus, this meta-analysis was intended to study the analgesic efficacy of pectoral nerve block for breast augmentation. METHODS Several databases including PubMed, EMbase, Web of Science, EBSCO, and Cochrane library databases were searched, and we included randomized controlled trials (RCTs) regarding the analgesic efficacy of pectoral nerve block for breast augmentation. RESULTS Six RCTs were ultimately included in this meta-analysis. Compared with control intervention for breast augmentation, pectoral nerve block could significantly reduce pain scores at 1 h (mean difference [MD] = -2.28; 95% confidence interval [CI] = -3.71 to -0.85; P = 0.002), 2 h (MD = -3.08; 95% CI = -3.95 to -2.20; P < 0.00001), 4 h (MD = -2.95; 95% CI = -3.32 to -2.58; P < 0.00001), 6-8 h (MD = -2.68; 95% CI = -3.24 to -2.11; P < 0.00001), 24 h (MD = -2.04; 95% CI = -2.41 to -1.67; P < 0.00001), the number of analgesic requirement (odd ratio [OR] = 0.20; 95% CI = 0.09 to 0.45; P = 0.0001), and the incidence of nausea (OR = 0.21; 95% CI = 0.08 to 0.54; P = 0.001) and vomiting (OR = 0.15; 95% CI = 0.05 to 0.39; P = 0.0001). Conclusions: Pectoral nerve block may be effective for pain relief after breast augmentation.
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Affiliation(s)
- Hailin Yang
- Department of thoracic and thyroid breast surgery, The People's Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Hao Wang
- Department of thoracic and thyroid breast surgery, The People's Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Qi Wang
- Department of thoracic and thyroid breast surgery, The People's Hospital of Yubei District of Chongqing City, Chongqing, China.
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PEC block versus local anesthetic infiltration in breast implant augmentation surgery: a retrospective study. Plast Reconstr Surg 2022; 150:319e-328e. [PMID: 35666162 DOI: 10.1097/prs.0000000000009292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pectoral plane (PEC) blocks are routinely used in analgesia for patients undergoing dual-plane breast augmentation with implants. Local anesthetic infiltration (LAI) is a simple alternative technique with the same aim. We evaluated both techniques. MM In this single-center retrospective study, patients received PEC block (ropivacaine 0.2%, 10 ml PEC I, 20 ml PEC II) or LAI. The primary outcome measure was pain, according to the visual analog scale (VAS), at 24h post-surgery. Secondary outcomes included the measure of pain at 1, 2, 6, and 12 hours post-surgery, total opioid consumption at 24h, and opioid side effects. RESULTS 81 were finally recruited: 37 in the PEC group and 44 in the LAI group. Patient characteristics were comparable between the two groups. At 24h post-surgery, the LAI group showed a decrease in pain, with a VAS score of 0.7 vs 1.5 in the PEC group (p = 0.007). There was no difference in VAS between the two groups at 1, 2, 6, or 12 hours post-surgery. The duration of anesthesia was increased in the PEC group with 153 minutes vs 120 minutes in the LAI group (p < 0.001). There was no difference in rescue morphine consumption between the two groups. CONCLUSIONS We found that LAI had a superior analgesic effect at 24h after surgery for dual-plane breast implant augmentation compared with PEC block. These findings are a good indication that the LAI technique is at least as effective as PEC block while being safe, fast, and easy to use.
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Chen IC, Kang YN, Wang HJ, Chiu WK, Chen C. The Efficacy of Local Anesthesia for Postoperative Pain Control in Breast Augmentation Surgery: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Aesthetic Plast Surg 2022; 46:1106-1115. [PMID: 35274178 DOI: 10.1007/s00266-022-02815-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/27/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Breast augmentation can cause severe postoperative pain; therefore, some surgeons perform wound infiltration with a local anesthetic solution. This study investigated the postoperative pain relief of local analgesics in breast augmentation surgery. METHODS We searched three databases for randomized controlled trials evaluating the outcomes of local wound irrigation with local analgesics during or after breast augmentation surgery. The solutions included ropivacaine, bupivacaine, bupivacaine plus ketorolac. The control groups may be saline alone or no irrigation. Network meta-analysis was further employed based on the frequentist approach. Outcomes were reported as weighted mean differences with 95% confidence intervals. RESULTS Comparisons between the interventions of our included studies revealed that only bupivacaine plus ketorolac (versus placebo) significantly reduced pain at 1 h postoperatively, as indicated by the visual analog scale pain score reduction of 2.22 (- 3.98, - 0.47). Other comparisons showed no significant differences. Moreover, three of the included studies reported postoperative medication use. Two of them reported that postoperative narcotic use was reduced, but the others did not report any such reduction. CONCLUSIONS Our results showed possibility that local irrigation with bupivacaine plus ketorolac might reduce pain 1 h after surgery. In addition, local anesthesia might reduce postoperative narcotic use. However, due to the small number of included studies, the clinical benefits of local anesthesia in breast augmentation surgery require further confirmation. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- I-Chun Chen
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan
| | - Yi-No Kang
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsian-Jenn Wang
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wen-Kuan Chiu
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Chiehfeng Chen
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Opioid-sparing Strategies in Alloplastic Breast Reconstruction: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3932. [PMID: 34796086 PMCID: PMC8594660 DOI: 10.1097/gox.0000000000003932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 12/30/2022]
Abstract
Introduction: Pain and discomfort are frequently experienced following mastectomy with concomitant breast implant- or tissue expander-based alloplastic breast reconstruction (AlBR). Unfortunately, postoperative opioids have decreased efficacy in AlBR, short-term complication profiles, and are fraught by long-term dependence. This systematic review aims to identify opioid-sparing pain management strategies in AlBR. Methods: A systematic literature search of MEDLINE, Embase, Web of Science, and Cochrane Central Register was performed in September 2018. PRISMA guidelines were followed, and the review was prospectively registered in PROSPERO (CRD42018107911). The search identified 1184 articles. Inclusion criteria were defined as patients 18 years or older undergoing AlBR. Results: Fourteen articles were identified assessing opioid-sparing strategies in AlBR. This literature included articles evaluating enhanced recovery protocols (two), intercostal blocks (two), paravertebral blocks (four), liposomal bupivacaine (three), diclofenac (one), and local anesthesia infusion pumps (two). The literature included five randomized trials and nine cohort studies. Study characteristics, bias (low to high risk), and reporting outcomes were extensively heterogeneous between articles. Qualitative analysis suggests reduced opioid utilization in enhanced recovery after surgery (ERAS) pathways, paravertebral blocks, and use of liposomal bupivacaine. Conclusions: A variety of opioid-sparing strategies are described for pain management in AlBR. Multimodal analgesia should be provided via ERAS pathways as they appear to reduce pain and spare opioid use. Targeted paravertebral blocks and liposomal bupivacaine field blocks appear to be beneficial in sparing opioids and should be considered as essential components of ERAS protocols. Additional prospective, randomized trials are necessary to delineate the efficacy of other studied modalities.
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Buckley CE, Concannon ES, Beecher SM, Kelly EJ. A double-blind, placebo-controlled randomised trial of intraparenchymal administration of local anaesthetic in elective breast augmentation. J Plast Reconstr Aesthet Surg 2021; 75:1204-1208. [PMID: 34895854 DOI: 10.1016/j.bjps.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/21/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Several methods of controlling pain post-bilateral breast augmentation (BBA) have been described. BBA is frequently performed as a day case procedure; therefore, a simple effective method of controlling pain in the immediate post-operative period is desired. METHODS We conducted a prospective, double-blinded, placebo-controlled randomised study of 20 women undergoing BBA. Women were randomly assigned to receive intraparenchymal infiltration intra-operatively prior to implant placement with either local anaesthetic (LA) (chirocaine) or normal saline. The primary outcome was post-operative pain scores immediately, and at 6 h. Our secondary endpoint was post-operative narcotic consumption. RESULTS Twenty patients were included in this study. The average pain score in the immediate post-operative period was 3.4 in the control group versus 0.7 in the treatment group (p = 0.013). In 6 h post-operatively, the average pain score was 2.4 in the control group versus 0.9 in the treatment group (p = 0.03). Sixty-six percentage of patients in the control arm required post-operative opiates compared with 27% in the treatment group (p = 0.17) CONCLUSION: This randomised controlled trial demonstrates a technique of intraparenchymal infiltration of LA that significantly reduces post-operative pain scores after BBA.
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Affiliation(s)
- Christina E Buckley
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
| | - Elizabeth S Concannon
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
| | - Suzanne M Beecher
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland.
| | - E Jason Kelly
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
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Yuan M, Wu J, Austin RE, Lista F, Ahmad J. Evaluating the Quality of Systematic Reviews and Meta-Analyses About Breast Augmentation Using AMSTAR. Aesthet Surg J Open Forum 2021; 3:ojab020. [PMID: 34240051 PMCID: PMC8259036 DOI: 10.1093/asjof/ojab020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Breast augmentation is one of the most commonly performed cosmetic surgeries worldwide. Therefore, it is imperative to have evidence with high methodological quality to guide clinical decision making. OBJECTIVES To evaluate the methodological quality of the systematic reviews (SRs) focused on breast augmentation. METHODS A comprehensive search of MEDLINE, Embase, and the Cochrane Library of Systematic Reviews was performed. SRs that have a particular focus on breast augmentation and were published in the top 15 plastic and reconstructive surgery journals were included. Quality assessment was performed using a measurement tool to assess systematic reviews (AMSTAR). Study characteristics were extracted including journal and impact factor, year of publication, country affiliation of the corresponding author, reporting adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, number of citations, and number of studies included. RESULTS Among the 22 studies included for analysis, the mean AMSTAR score was moderate (5.55), with no SR achieving good quality (AMSTAR score of ≥9). There were no significant associations between AMSTAR score and journal impact factor, number of citations, year of publication, or number of included studies. Studies that reported adherence to PRISMA guidelines on average scored higher on the AMSTAR tool (P = 0.03). CONCLUSIONS The methodological quality of reviews about breast augmentation was found to be moderate, with no significant increase in studies or quality over time. Adherence to PRISMA guidelines and increased appraisal of SRs about breast augmentation using methodological assessment tools would further strengthen methodological quality and confidence in study findings.
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Affiliation(s)
- Morgan Yuan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jeremy Wu
- University of Toronto, Toronto, ON, Canada
| | | | - Frank Lista
- Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jamil Ahmad
- Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Pectoral Nerve Blocks for Breast Augmentation Surgery: A Randomized, Double-blind, Dual-centered Controlled Trial. Anesthesiology 2021; 135:442-453. [PMID: 34195767 DOI: 10.1097/aln.0000000000003855] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pectoral nerve blocks have been proposed for analgesia during and after breast cancer surgery, but data are conflicted in aesthetic breast surgery. This trial tested the primary hypothesis that adding a preincisional pectoral nerve block is superior to systemic multimodal analgesic regimen alone for pain control after breast augmentation surgery. A second hypothesis is that rescue opioid consumption would be decreased with a long-lasting effect for both outcomes during the following days. METHODS Seventy-three adult female patients undergoing aesthetic breast augmentation surgery under general anesthesia were randomly allocated to receive a pectoral nerve block versus no block. Both groups received standard care with protocolized multimodal analgesia alone including systematic acetaminophen and nonsteroidal anti-inflammatory drugs. The primary outcome measure was the maximal numerical rating scale in the first 6 h after extubation. Secondary outcomes included intraoperative remifentanil consumption and from extubation to day 5: maximal numerical rating scale, postoperative cumulative opioid consumption and postoperative opioid side effects, and patient satisfaction recorded at day 5. RESULTS The maximal numerical rating scale score in the first 6 h was lower in the pectoral nerve block group compared with the control group (3.9 ± 2.5 vs. 5.2 ± 2.2; difference: -1.2 [95% CI, -2.3 to -0.1]; P = 0.036). The pectoral nerve block group had a lower maximal numerical rating scale between days 1 and 5 (2.2 ± 1.9 vs. 3.2 ± 1.7; P = 0.032). The cumulative amount of overall opioids consumption (oral morphine equivalent) was lower for the pectoral nerve block group from hour 6 to day 1 (0.0 [0.0 to 21.0] vs. 21.0 [0.0 to 31.5] mg, P = 0.006) and from days 1 to 5 (0.0 [0.0 to 21.0] vs. 21.0 [0.0 to 51] mg, P = 0.002). CONCLUSIONS Pectoral nerve block in conjunction with multimodal analgesia provides effective perioperative pain relief after aesthetic breast surgery and is associated with reduced opioid consumption over the first 5 postoperative days. EDITOR’S PERSPECTIVE
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Wallace CC, Wetzel ME, Howell C, Vasconez HC. The Efficacy of Pectoralis Nerve Blockade in Breast Reductions: A Prospective Randomized Trial. Ann Plast Surg 2021; 86:S632-S634. [PMID: 33625027 DOI: 10.1097/sap.0000000000002763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pectoralis nerve (Pecs) blocks have been shown to reduce perioperative opioid consumption in patients undergoing mastectomies, but the effectiveness of these blocks in breast reductions has not been established. This trial aims to evaluate the efficacy of Pecs blocks (I and II) on perioperative pain management in patients undergoing breast reductions. METHODS Thirty-six patients were enrolled in the randomized controlled trial divided into 2 groups. The treatment group (n = 16) received general anesthesia plus postinduction ultrasound-guided Pecs blocks. The control group (n = 20) received general anesthesia alone. The primary outcomes measured were perioperative narcotic requirements, need for postoperative antiemetics, pain scores, and length of time in the operating room (OR). We measured patient and procedural risk factors including pedicle/skin excision patterns, concurrent liposuction, weight of resection, and additional local anesthesia. Risk factors as well as outcomes were analyzed using Fischer exact and t tests. RESULTS No statistically significant difference was shown between the group receiving the Pecs blocks and the control with regard to narcotic requirements, pain scores, and need for antiemetics. Patients undergoing Pecs blocks had a significantly higher OR time before incision (P = 0.0073). Patient and procedural risk factors were well balanced (P > 0.41). CONCLUSIONS Pectoralis nerve blocks may be a valuable component of a multimodality pain regimen; however, when performed as a solitary adjunct, they do not seem to decrease perioperative narcotic requirements, pain scores, or the need for antiemetic medication in patients undergoing breast reductions. In addition, postinduction Pecs blocks significantly increase OR times.
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Affiliation(s)
- Chelsea C Wallace
- From the Division of Plastic Surgery, University of Kentucky, Lexington, KY
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Ciftci B, Ekinci M, Celik EC, Karaaslan P, Tukac İC. Ultrasound-guided pectoral nerve block for pain control after breast augmentation: a randomized clinical study. Braz J Anesthesiol 2020; 71:44-49. [PMID: 33712252 PMCID: PMC9373212 DOI: 10.1016/j.bjane.2020.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/03/2020] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Pectoral nNerve (PECS) block type-1 is an Ultrasound (US)-guided interfacial block that can be performed for postoperative analgesia management after breast surgery. In the procedure, a local anesthetic solution is injected into the interfacial area between the Pectoralis Major muscles (PMm) and Pectoralis minor muscles (Pmm). The present study compared PECS block type-1 administered preoperatively or postoperatively for postoperative analgesia after breast augmentation surgery. METHODS The patients were randomly divided into three groups (n = 30 in each): a preoperative PECS block group (Pregroup), postoperative PECS block group (Postgroup), and control group (Group C). Opioid consumption and Visual Analogue Scale (VAS) scores were evaluated at postoperative period. RESULTS The pains scores in the Pregroup were significantly lower than those in the control group. Although there was no significantly difference in the VAS scores of the Postgroup and control group at postoperative 1 hour, the scores in the Postgroup were significantly lower than those in the control group at all the other evaluated times (p < 0.05). The VAS scores in the Pregroup were significantly lower than those in the Postgroup 8 hours after the surgery. Opioid consumption was significantly lower in the Pregroup as compared with that in the other two groups (p < 0.05). The use of rescue analgesia in the Pregroup was significantly lower than that in the other groups (p < 0.05). CONCLUSION Performing PECS block type-1 preoperatively reduced VAS scores and opioid consumption after breast augmentation.
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Affiliation(s)
- Bahadır Ciftci
- Istanbul Medipol University, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
| | - Mursel Ekinci
- Istanbul Medipol University, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - Erkan Cem Celik
- Erzurum Regional Training and Research Hospital, Department of Anesthesiology and Reanimation, Erzurum, Turkey
| | - Pelin Karaaslan
- Istanbul Medipol University, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - İsmail Cem Tukac
- Istanbul Medipol University, Department of Anesthesiology and Reanimation, Istanbul, Turkey
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Desroches J, Roy M, Belliveau M, Leblanc B, Beaulieu P. [PECS I block for postoperative analgesia in patients undergoing breast augmentation surgery: a randomized double-blind placebo-controlled study]. Rev Bras Anestesiol 2020; 70:333-342. [PMID: 32792131 DOI: 10.1016/j.bjan.2020.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 03/24/2020] [Accepted: 04/14/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES PECS I block was first described for surgery involving the pectoralis muscles. No randomized clinical trial has been conducted on surgeries that directly involve these muscles, such as subpectoral breast augmentation. We hypothesized that PECS I block would decrease pain in the postoperative period in this population. METHODS This was a randomized, double-blind, placebo-controlled trial in women undergoing subpectoral breast augmentation surgery. PECS I block was performed using 0.4 mL.kg-1 of 0.9% saline on one side and bupivacaine (0.25%) on the other side, each patient being her own control. Numeric Rating Scale (NRS) pain scores (0-10) were measured at rest and during movement. The primary outcome was pain score at rest 30 minutes after arrival in the PACU. To detect a clinically significant difference of 50% in pain reduction, 14 volunteers were enrolled (power of 90% and alpha<0.05). RESULTS In the PACU, three patients had no difference in pain between sides, five had reduced pain on the placebo side, and six had reduced pain on the bupivacaine side. In the bupivacaine group, pain scores at rest at 5, 30 and 60 minutes and 24 hours were 4.89 (4.23-5.56; mean 95% CI), 3.75 (3.13-4.37), 3.79 (2.93-4.64), and 2.29 (1.56-3.01), respectively, whereas in the placebo group, they were 4.96 (4.32-5.60), 4.00 (3.50-4.49), 3.93 (3.12-4.73), and 2.29 (1.56-3.01), respectively. CONCLUSIONS PECS I block in patients undergoing breast augmentation surgery does not provide better pain relief than placebo. Therefore, the indications for PECS I block in breast augmentation surgery should be reconsidered.
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Affiliation(s)
- Jean Desroches
- Clinique Chirurgicale de Laval, Department of Anesthesiology, Laval, Canada
| | - Maxim Roy
- Centre Hospitalier de l'Université de Montréal, Department of Anesthesiology, Montreal, Canada.
| | - Marc Belliveau
- Hôtel-Dieu de St Jérôme, Department of Anesthesiology, Saint-Jérôme, Canada
| | - Benoit Leblanc
- Clinique Chirurgicale de Laval, Department of Surgery, Laval, Canada
| | - Pierre Beaulieu
- Centre Hospitalier de l'Université de Montréal, Department of Anesthesiology, Montreal, Canada
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Desroches J, Roy M, Belliveau M, Leblanc B, Beaulieu P. PECS I block for postoperative analgesia in patients undergoing breast augmentation surgery: a randomized double-blind placebo-controlled study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 32792131 PMCID: PMC9373589 DOI: 10.1016/j.bjane.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Background and objectives Methods Results Conclusions
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Arnica montana and Bellis perennis for seroma reduction following mastectomy and immediate breast reconstruction: randomized, double-blind, placebo- controlled trial. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-019-01618-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Sheckter CC, Rochlin D, Kiwanuka H, Curtin C, Momeni A. The impact of hospital volume on patient safety indicators following post-mastectomy breast reconstruction in the US. Breast Cancer Res Treat 2019; 178:177-183. [PMID: 31338643 DOI: 10.1007/s10549-019-05361-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Despite the growing spotlight on value-based care and patient safety, little is known about the influence of patient-, reconstruction-, and facility-level factors on safety events following breast reconstruction. The purpose of this study is to characterize postoperative complications in light of hospital-level risk factors. METHODS Using the National Inpatient Sample, all patients who underwent free flap and prosthetic breast reconstruction from 2012 to 2014 were identified. Predictor variables included patient demographic and clinical characteristics, type and timing of reconstruction, annual hospital reconstructive volume, hospital bed size, hospital setting (rural vs. urban), and length of stay. Patient safety indicators (PSIs) were based on the Agency for Healthcare Research and Quality's designation of preventable hospital complications: venous thromboembolism, bleeding, wound complications, pneumonia, and sepsis. Logistic models were used to analyze outcomes. RESULTS The sample included 103,301 women, of which 27,695 (26.8%) underwent free flap reconstruction. 3.6% of patients experienced ≥ 1 PSI, most commonly wound PSI (4.9% and 2.5% for free flap and prosthetic reconstruction, respectively). Significant predictors of PSIs included rural setting (p < 0.01) and Elixhauser score ≥ 4 (p < 0.01) for the free flap group, and delayed reconstruction (p < 0.01) for the prosthetic group. Annual reconstructive facility volume was not associated with increased odds of PSIs in either prosthetic or free flap reconstruction (p > 0.05). CONCLUSION PSIs were associated with rural hospitals and greater comorbidities for patients undergoing reconstruction with free flaps. Annual reconstructive facility volume was not associated with adverse inpatient outcomes with either method of reconstruction.
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Affiliation(s)
- Clifford C Sheckter
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, 770 Welch Road, Suite 400, Palo Alto, CA, 94304, USA
| | - Danielle Rochlin
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, 770 Welch Road, Suite 400, Palo Alto, CA, 94304, USA
| | - Harriet Kiwanuka
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, 770 Welch Road, Suite 400, Palo Alto, CA, 94304, USA
| | - Catherine Curtin
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, 770 Welch Road, Suite 400, Palo Alto, CA, 94304, USA.,Division of Plastic and Reconstructive Surgery, Veterans Affairs Palo Alto, Palo Alto, CA, USA
| | - Arash Momeni
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, 770 Welch Road, Suite 400, Palo Alto, CA, 94304, USA.
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Ekinci M, Ciftci B, Celik EC, Karakaya MA, Demiraran Y. The Efficacy of Different Volumes on Ultrasound-Guided Type-I Pectoral Nerve Block for Postoperative Analgesia After Subpectoral Breast Augmentation: A Prospective, Randomized, Controlled Study. Aesthetic Plast Surg 2019; 43:297-304. [PMID: 30756142 DOI: 10.1007/s00266-019-01322-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/24/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND PECS type-1 block, a US-guided superficial interfacial block, provides effective analgesia after breast surgery. Aesthetic breast augmentation is one of the most common surgical procedures in plastic surgery. Subpectoral prostheses cause severe pain. The aim of this study was to investigate the effect of different volumes of the solution on the efficacy of PECS type-I block for postoperative analgesia after breast augmentation surgery. METHODS Ninety ASA status I-II female patients aged between 18 and 65 years who scheduled breast augmentation surgery under general anesthesia were included in this study. The patients were randomly divided into three groups of 30 patients each (Group 20 = 20 ml of anaesthetic solution, Group 30 = 30 ml anaesthetic solution, and Group K = Control group). Postoperative assessment was performed using the VAS score. The VAS scores were recorded postoperatively at 1, 2, 4, 8, 16 and 24 h. RESULTS Fentanyl consumption was statistically significantly lower in Group 20 and Group 30 compared to the Control group (p < 0.05). There was no statistically significant difference in fentanyl consumption between Group 20 and Group 30. The right and left VAS scores were statistically significantly lower in Groups 20 and 30 than in the Control group (p < 0.05). There was no statistical difference in terms of VAS scores between Group 20 and Group 30. The use of rescue analgesia was statistically lower in Groups 20 and 30. CONCLUSIONS PECS type-1 block using 20 ml of 0.25% bupivacaine can provide effective analgesia after breast augmentation surgery. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Mursel Ekinci
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, 34000, Bagcilar, Istanbul, Turkey
| | - Bahadir Ciftci
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, 34000, Bagcilar, Istanbul, Turkey.
| | - Erkan Cem Celik
- Department of Anesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, 25070, Yakutiye, Erzurum, Turkey
| | - Muhammet Ahmet Karakaya
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, 34000, Bagcilar, Istanbul, Turkey
| | - Yavuz Demiraran
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, 34000, Bagcilar, Istanbul, Turkey
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Bourazani M, Papageorgiou E, Zarkadas G, Petrakopoulou T, Kaba E, Fasoi G, Kelesi M. The Role of Muscle Relaxants – Spasmolytic (Thiocochlicoside) in Postoperative Pain Management after Mastectomy and Breast Reconstruction. Asian Pac J Cancer Prev 2019; 20:743-749. [PMID: 30909680 PMCID: PMC6825793 DOI: 10.31557/apjcp.2019.20.3.743] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: Post-operative pain after breast cancer surgery is a major problem and women undergoing mastectomy and breast reconstruction experience post-operative pain syndromes in approximately one-half of all cases. Patients who have undergone breast reconstruction after mastectomy can suffer from acute postoperative pain with moderate or strong tension. In some cases, chronic neuropathic pain syndromes may occur after surgery. Opioids are used to treat pain, with serious side effects. The systemic postoperative analgesic regimen as thiocochlicoside P.O. along with paracetamol and NSAIDs I.V., which may limit the administration of opioids without reducing pain relief, seems to be necessary. Materials and Methods: This study was a clinical trial randomizing 70 patients undergoing breast reconstruction. Two main protocols of systematic post-operative analgesia, one using thiocochlicoside (group A) and the other without them (group B), were used. Both groups received paracetamol X3 and lornoxicam X2 I.V. systematically. The pain measurement scale (NPS) used to measure post-operative pain. Likert scales were used to evaluate patient’s satisfaction and the difficulty from the side effects . An anonymous questionnaire was used for the data collection. Results: Statistically significant difference was found between pain on the day of surgery (p = 0.017) as well as the three subsequent days (p = 0.000). In group A , pain was reduced directly to half (Χ2 surgery pain = 93.888, p = 0.000) especially on the first post-operative day. In group A the satisfaction with analgesic treatment was higher than in group B (p = 0.002). Conclusion: The use of thiocochlicoside in post-operative analgesia in breast reconstruction after mastectomy contributes to reduce the pain intensity experienced by patients and to reduce the side effects of opioid analgesics as a result of reduced demand for opioid analgesics. Patients who received the analgesia using muscle relaxants-spasmolytic reported greater satisfaction.
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Affiliation(s)
- Maria Bourazani
- Department of Anesthesiology, Hellenic Anticancer Institute, Saint Savvas Hospital, Greece.
| | | | | | | | - Evridiki Kaba
- Department of Nursing, University of West Attikis, Greece
| | - Georgia Fasoi
- Department of Nursing, University of West Attikis, Greece
| | - Martha Kelesi
- Department of Nursing, Technological Educational Institute of Athens, Athens, Greece
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Implementing Precision Medicine and Artificial Intelligence in Plastic Surgery: Concepts and Future Prospects. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2113. [PMID: 31044104 PMCID: PMC6467615 DOI: 10.1097/gox.0000000000002113] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/28/2018] [Indexed: 12/17/2022]
Abstract
Precision medicine, or the individualization of evidence-based medicine, is forthcoming. As surgeons, we must be prepared for the integration of patient and system factors. Plastic surgeons regard themselves as innovators and early adopters. As such, we need our adaptability now more than ever to implement digital advancements and precision medicine into our practices. The integration of artificial intelligence (AI) technology and the capture of big data techniques should foster the next great leaps in medicine and surgery, allowing us to capture the detailed minutiae of precision medicine. The algorithmic process of artificial neural networks will guide large-scale analysis of data, including features such as pattern recognition and rapid quantification, to organize and distribute data to surgeons seamlessly. This vast digital collection of information, commonly termed “big data,” is only one potential application of AI. By incorporating big data, the cognitive abilities of a surgeon can be complemented by the computer to improve patient-centered care. Furthermore, the use of AI will provide individual patients with increased access to the broadening world of precision medicine. Therefore, plastic surgeons must learn how to use AI within the contexts of our practices to keep up with an evolving field in medicine. Although rudimentary in its practice, we present a glimpse of the potential applications of AI in plastic surgery to incorporate the practice of precision medicine into the care that we deliver.
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Schuitemaker R JB, Sala-Blanch X, Sánchez Cohen AP, López-Pantaleon LA, Mayoral R JT, Cubero M. Analgesic efficacy of modified pectoral block plus serratus plane block in breast augmentation surgery: A randomised, controlled, triple-blind clinical trial. ACTA ACUST UNITED AC 2018; 66:62-71. [PMID: 30674430 DOI: 10.1016/j.redar.2018.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Prosthetic breast surgery is a very common plastic surgery procedure, but its postoperative analgesic management is a challenge for the surgical team. The purpose of the present study is to validate the analgesic efficacy of pectoral block and serratus plane block in retropectoral mammoplasty. PATIENTS AND METHODS A randomised, controlled, triple-blind, clinical trial was designed, and included 30 patients undergoing retropectoral augmentation mammoplasty. All of them had a modified PECII block and a serratus plane block with a total volume of 40ml per breast. In 15 of them bupivacaine 0.25% (GPEC) was injected and in the other 15 patients saline was used (GC). Standardised management of anaesthesia and postoperative analgesia was performed. Intra-operative haemodynamic parameters required for postoperative analgesia, and a numeric verbal scale on arrival in the recovery unit were measured and at 3, 6, and 24h. The quality perceived by patients and surgeons was also measured. RESULTS Post-operative pain was significantly better in GPEC (5.3±2.3 vs. 2.9±2.7; P=.018). No significant differences were observed at 3, 6, and 24h. The surgeons rated the anaesthetic-analgesic quality as very good in 80% of the cases in GPEC versus 33% in CG (P=.01). CONCLUSIONS The use of these blocks is a good perioperative analgesic strategy in the multimodal management of retropectoral augmentation mammoplasty.
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Affiliation(s)
- J B Schuitemaker R
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, QuironSalud Hospital Universitari General de Catalunya e Hypnos S.L.P., Sant Cugat del Vallès, Barcelona, España.
| | - X Sala-Blanch
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínic de Barcelona, Departamento de Anatomía Humana, Universitat de Barcelona, Barcelona, España
| | - A P Sánchez Cohen
- Servicio de Radiología Intervencionista, Invenciones Tecnológicas en Medicina (INTEM), QuironSalud Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - L A López-Pantaleon
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, QuironSalud Hospital Universitari General de Catalunya e Hypnos S.L.P., Sant Cugat del Vallès, Barcelona, España
| | - J T Mayoral R
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, QuironSalud Hospital Universitari General de Catalunya e Hypnos S.L.P., Sant Cugat del Vallès, Barcelona, España
| | - M Cubero
- Sección de Estadística, Facultad de Biología, Universitat de Barcelona, Barcelona, España
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Govrin-Yehudain O, Matanis Y, Govrin-Yehudain J. Reduced Pain and Accelerated Recovery Following Primary Breast Augmentation With Lightweight Breast Implants. Aesthet Surg J 2018; 38:1092-1096. [PMID: 29579148 PMCID: PMC6137425 DOI: 10.1093/asj/sjy071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The posttreatment pain associated with breast augmentation is a top concern of most patients and can affect the decision concerning surgery. OBJECTIVES This study aimed to compare the posttreatment pain and recovery times of patients undergoing primary breast augmentation with lightweight vs full-mass implants of similar volumes. The authors hypothesized that the reduced mechanical strain applied by lightweight implants elicits less pain. METHODS In this retrospective, observational study, 100 women who had undergone primary breast augmentation with either a lightweight breast implant or a traditional full-mass silicone implant (n = 50), were contacted by phone and asked about their posttreatment experiences and overall satisfaction with the outcome. All women were treated by the same surgical team, and the two groups were matched by date of surgery. RESULTS Most patients in the two cohorts had a self-reported preoperative B cup size and relatively high tolerance to pain. On average, LWBI patients were 6 years older than those undergoing full-mass implantation (32.4 ± 8.7 vs 26.2 ± 8.0; P = .0004) and more had experienced at least one pregnancy (61.2% vs 24%, P = .0002). LWBI patients opted for implants 39 ± 28.4 cc larger than patients in the control group. Subglandular placement was selected in most cases (LWBI: 83.7% and full-mass: 90.0%). Mean posttreatment pain was lower in the LWBI cohort (5.5 ± 2.4 vs 6.5 ± 2.4) and required a shorter duration of analgesics (3.87 ± 1.77 days vs 5.26 ± 2.94 days; P = .009). Age- and parity-adjusted measures demonstrated a respective 2-day and 5-day shorter recovery period and return to normal activities interval in the LWBI versus full-mass implant cohorts (P = .04 and P = .002, respectively). CONCLUSIONS As compared to traditional silicone filled full-mass implants, breast augmentations with B-Lite lightweight breast implants (G&G Biotechnology Ltd., Haifa, Israel) elicit less posttreatment pain and require less down-time, ultimately, meeting patients' quest for desired breast shape at minimal discomfort. LEVEL OF EVIDENCE 3
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Affiliation(s)
| | - Yossef Matanis
- Department of Anesthesiology, Italian Hospital, Haifa, Israel
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Ropivacaine in Breast Augmentation Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1745. [PMID: 29922549 PMCID: PMC5999429 DOI: 10.1097/gox.0000000000001745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/12/2018] [Indexed: 11/27/2022]
Abstract
Background: Breast augmentation surgery is still 1 of the most popular procedures in plastic surgery. Like other surgical procedures, it has been traditionally handled with nonsteroidal anti-inflammatory drugs and narcotics, which had many adverse effects; therefore, alternatives with the same effectiveness are being researched. The aim of this study was to investigate the efficacy of ropivacaine breast pocket irrigation during primary breast augmentation surgery to control pain during the first postoperative hours. Methods: A multicenter, prospective, double-blind, randomized trial was performed on 52 primary breast augmentation procedures in which patients served as their own control: One breast received ropivacaine pocket irrigation and the other placebo. All patients received an oral analgesic. Pain was evaluated with a visual analogue scale at 30, 60, 90, and 120 minutes postoperatively. Results: Pain was significantly less in ropivacaine breast at 90 and 120 minutes postoperatively (P = 0.027 and 0.022, respectively). There was no statistical significance when the type of anesthesia used, general or epidural, was compared (P = 0.33 and P = 0.37 at 90 and 120 minutes, respectively). Conclusions: Ropivacaine irrigation in breast pocket is able to diminish early postoperative pain safely, being an alternative to other analgesic methods.
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The Efficacy of Ultrasound-guided Type II Pectoral Nerve Blocks in Perioperative Pain Management for Immediate Reconstruction After Modified Radical Mastectomy. Clin J Pain 2018; 34:231-236. [DOI: 10.1097/ajp.0000000000000529] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tan P, Martin M, Shank N, Myers L, Wolfe E, Lindsey J, Metzinger S. A Comparison of 4 Analgesic Regimens for Acute Postoperative Pain Control in Breast Augmentation Patients. Ann Plast Surg 2017; 78:S299-S304. [PMID: 28459704 PMCID: PMC6686898 DOI: 10.1097/sap.0000000000001132] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Patients undergoing breast augmentation are treated with multiple combinations of medications for pain control including ketorolac, liposomal bupivacaine, bupivacaine, and intravenous and oral narcotics. There is no current consensus on the optimal combination; therefore, all are used at the discretion of the surgeon. METHODS This was a single-center, retrospective study. The total number of patients included was 132. Comparisons were made between 4 groups: bupivacaine only (B); bupivacaine and liposomal bupivacaine (BL); bupivacaine and liposomal bupivacaine plus intraoperative ketorolac (BLKi); and bupivacaine and liposomal bupivacaine plus postoperative ketorolac (BLKp). Average pain scores immediately postoperative and before discharge were recorded and correlated to percentage of patients who received narcotic in the post-anesthesia care unit (PACU). Additional end points noted were side effects including nausea and time spent in PACU postoperatively. RESULTS Those receiving intraoperative ketorolac had the lowest pain on discharge (P < 0.0001) and the lowest percentage of patients receiving narcotics (P = 0.009) out of all 4 groups. There was no significant difference between the 4 groups in terms of time spent in PACU, pain immediately after the procedure, or amount of antiemetic given. No bleeding complications were noted for those who did or did not receive ketorolac. CONCLUSIONS When given options for pain control in breast augmentation, intraoperative ketorolac should be considered, because its inclusion was significant in decreasing use of narcotics and pain upon discharge. Addition of other costly drugs such as liposomal bupivacaine may not provide additional benefit in the immediate postoperative setting for procedures with a short recovery period such as breast augmentation.
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Affiliation(s)
- Pamela Tan
- Tulane University Division of Plastic and Reconstructive Surgery, New Orleans, LA
| | - Morgan Martin
- Tulane University Division of Plastic and Reconstructive Surgery, New Orleans, LA
| | - Nina Shank
- Tulane University Division of Plastic and Reconstructive Surgery, New Orleans, LA
| | - Leann Myers
- Tulane University Department of Biostatistics and Bioinformatics, New Orleans, LA
| | - Emily Wolfe
- Tulane University Division of Plastic and Reconstructive Surgery, New Orleans, LA
| | - John Lindsey
- Tulane University Division of Plastic and Reconstructive Surgery, New Orleans, LA
| | - Stephen Metzinger
- Tulane University Division of Plastic and Reconstructive Surgery, New Orleans, LA
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Comparison of pain, nausea, and complications in outpatient and inpatient breast augmentation. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-017-1316-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Shah A, Rowlands M, Krishnan N, Patel A, Ott-Young A. Thoracic Intercostal Nerve Blocks Reduce Opioid Consumption and Length of Stay in Patients Undergoing Implant-Based Breast Reconstruction. Plast Reconstr Surg 2015; 136:584e-591e. [DOI: 10.1097/prs.0000000000001717] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A randomized controlled trial of postoperative pain control after subpectoral breast augmentation using intercostal nerve block versus bupivacaine pectoralis major infiltration: A pilot study. J Plast Reconstr Aesthet Surg 2015; 68:e83-4. [DOI: 10.1016/j.bjps.2014.12.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 10/06/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
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