Intraoperative Intercostal Nerve Block for Postoperative Pain Control in Pre-Pectoral versus Subpectoral Direct-To-Implant Breast Reconstruction: A Retrospective Study
Open Access
- 30 June 2020
- Vol. 56 (7), 325
- https://doi.org/10.3390/medicina56070325
Abstract
Background and Objectives: Patients undergoing mastectomy and implant-based breast reconstruction have significant acute postsurgical pain. The purpose of this study was to examine the efficacy of intercostal nerve blocks (ICNBs) for reducing pain after direct-to-implant (DTI) breast reconstruction. Materials and Methods: Between January 2019 and March 2020, patients who underwent immediate DTI breast reconstruction were included in this study. The patients were divided into the ICNB or control group. In the ICNB group, 4 cc of 0.2% ropivacaine was injected intraoperatively to the second, third, fourth, and fifth intercostal spaces just before implant insertion. The daily average and maximum visual analogue scale (VAS) scores were recorded by the patient from operative day to postoperative day (POD) seven. Pain scores were compared between the ICNB and control groups and analyzed according to the insertion plane of implants. Results: A total of 67 patients with a mean age of 47.9 years were included; 31 patients received ICNBs and 36 patients did not receive ICNBs. There were no complications related to ICNBs reported. The ICNB group showed a significantly lower median with an average VAS score on the operative day (4 versus 6, p = 0.047), lower maximum VAS scores on the operative day (5 versus 7.5, p = 0.030), and POD 1 (4 versus 6, p = 0.030) as compared with the control group. Among patients who underwent subpectoral reconstruction, the ICNB group showed a significantly lower median with an average VAS score on the operative day (4 versus 7, p = 0.005), lower maximum VAS scores on the operative day (4.5 versus 8, p = 0.004), and POD 1 (4 versus 6, p = 0.009), whereas no significant differences were observed among those who underwent pre-pectoral reconstruction. Conclusions: Intraoperative ICNBs can effectively reduce immediate postoperative pain in subpectoral DTI breast reconstruction; however, it may not be effective in pre-pectoral DTI reconstruction.Keywords
This publication has 39 references indexed in Scilit:
- The Use of Intercostal Nerve Blocks for Implant-Based Breast SurgeryPlastic and Reconstructive Surgery, 2013
- Ultrasound description of Pecs II (modified Pecs I): A novel approach to breast surgeryRevista Española de Anestesiología y Reanimación, 2012
- The Use of Acellular Dermal Matrices in Two-Stage Expander/Implant ReconstructionPlastic and Reconstructive Surgery, 2012
- Efficacy and safety of paravertebral blocks in breast surgery: a meta-analysis of randomized controlled trialsBritish Journal of Anaesthesia, 2010
- Barriers to rehabilitation following surgery for primary breast cancerJournal of Surgical Oncology, 2007
- Treatment-Related Factors Predisposing to Chronic Pain in Patients with Breast CancerA Multivariate ApproachActa Oncologica, 1997
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databasesJournal of Clinical Epidemiology, 1992
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987
- Innervation of Periosteum and Bone by Sympathetic Vasoactive Intestinal Peptide-Containing Nerve FibersScience, 1986
- Anesthesia for Radical Mastectomy with Intravenous Pentothal Sodium and Intercostal Nerve BlockThe New England Journal of Medicine, 1946