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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2016

01-02-2016 | Breast Oncology

Comparative Study of Liposomal Bupivacaine Versus Paravertebral Block for Pain Control Following Mastectomy with Immediate Tissue Expander Reconstruction

Authors: Jad M. Abdelsattar, MBBS, Judy C. Boughey, MD, Aodhnait S. Fahy, BMBCh, PhD, James W. Jakub, MD, David R. Farley, MD, Tina J. Hieken, MD, Amy C. Degnim, MD, Whitney Goede, PharmD, Anita T. Mohan, MRCS, William S. Harmsen, MSc, Adam D. Niesen, MD, Nho V. Tran, MD, Karim Bakri, MBBS, Steven R. Jacobson, MD, Valerie Lemaine, MD, Michel Saint-Cyr, MD

Published in: Annals of Surgical Oncology | Issue 2/2016

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Abstract

Background

Several approaches to minimize postoperative pain, nausea, and enhance recovery are available for patients undergoing mastectomy with immediate tissue expander (TE) reconstruction. We compared the effectiveness of intraoperative local infiltration of liposomal bupivacaine (LB) to preoperative paravertebral block (PVB).

Methods

We retrospectively reviewed patients who underwent mastectomy with immediate TE reconstruction between May 2012 and October 2014 and compared patients with preoperative ultrasound-guided PVB to those with intraoperative LB infiltration.

Results

Fifty-three patients (54.6 %) received LB and 44 received PVB. LB was associated with less opioid use in the recovery room (p < 0.001), fewer patients requiring antiemetics (p = 0.03), and lower day of surgery pain scores (p = 0.008). LB also was associated with longer time to first opioid use (p = 0.04). On multivariable analysis controlling for expander placement location, year of surgery, and axillary lymph node dissection (ALND), the only variable that remained statistically significant was lower opioid use in the recovery room for patients with LB (p = 0.03) and day of surgery pain scores approached significance (p = 0.05). There was no difference in the proportion of patients discharged within 36 h of surgery between the groups. Focusing on first cases of the day (where PVBs are performed in the OR) showed average time to skin incision was 15 min shorter in the LB group (p = 0.004).

Conclusions

Local infiltration of LB in patients undergoing mastectomy with immediate TE reconstruction decreases narcotic requirements in the recovery room, shortens preoperative anesthesiology time, and provides similar, if not better, perioperative pain control compared with PVB.
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Metadata
Title
Comparative Study of Liposomal Bupivacaine Versus Paravertebral Block for Pain Control Following Mastectomy with Immediate Tissue Expander Reconstruction
Authors
Jad M. Abdelsattar, MBBS
Judy C. Boughey, MD
Aodhnait S. Fahy, BMBCh, PhD
James W. Jakub, MD
David R. Farley, MD
Tina J. Hieken, MD
Amy C. Degnim, MD
Whitney Goede, PharmD
Anita T. Mohan, MRCS
William S. Harmsen, MSc
Adam D. Niesen, MD
Nho V. Tran, MD
Karim Bakri, MBBS
Steven R. Jacobson, MD
Valerie Lemaine, MD
Michel Saint-Cyr, MD
Publication date
01-02-2016
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 2/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4833-4

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