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Annals of Surgical Oncology

, Volume 20, Issue 4, pp 1282–1286 | Cite as

Use of Preoperative Paravertebral Block Decreases Length of Stay in Patients Undergoing Mastectomy Plus Immediate Reconstruction

  • Suzanne B. Coopey
  • Michelle C. Specht
  • Lisa Warren
  • Barbara L. Smith
  • Jonathan M. Winograd
  • Katharine Fleischmann
Breast Oncology

Abstract

Background

A prior study in patients undergoing breast surgery with and without the use of paravertebral blocks (PVB) found no significant difference in patient length of stay (LOS). However, patients undergoing bilateral procedures and those undergoing immediate reconstructions were excluded. We sought to determine if the use of PVB in patients undergoing unilateral or bilateral mastectomy plus immediate reconstruction decreases patient LOS.

Methods

We undertook a retrospective review of patients who had mastectomies with immediate reconstructions with and without the use of preoperative PVB. Outcomes including LOS, postoperative nausea and vomiting, and time to oral narcotics were compared between groups.

Results

Mean LOS for the PVB group was 42 h. This was significantly less than the mean LOS of 47 h for the nonblock group (p = .0015). The significantly lower LOS for the PVB group was true for patients undergoing bilateral procedures (p = .045), unilateral procedures (p = .0031), tissue expander placement (p = .0114), and immediate implant placement (p = .037). Mean time to conversion to oral narcotics was significantly shorter in the PVB group (15 h) compared with the nonblock group (20 h) (p < .001). The incidence of postoperative nausea in the PVB group (42.8 %) was also significantly less than in the nonblock group (54.7 %) (p = .031).

Conclusions

The routine use of preoperative PVB in patients undergoing mastectomy plus immediate reconstruction significantly decreased patient LOS. In addition to improved pain control from the block itself, quicker conversion to oral narcotics because of less postoperative nausea likely contributed to a decreased LOS.

Keywords

Sentinel Lymph Node Biopsy Axillary Lymph Node Dissection Postoperative Nausea Contralateral Prophylactic Mastectomy Breast Conservation Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

The authors would like to thank Eric Coopey MCS for his assistance with the statistical analysis portion of this study.

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Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Suzanne B. Coopey
    • 1
  • Michelle C. Specht
    • 1
  • Lisa Warren
    • 2
  • Barbara L. Smith
    • 1
  • Jonathan M. Winograd
    • 3
  • Katharine Fleischmann
    • 2
  1. 1.Surgical OncologyMassachusetts General HospitalBostonUSA
  2. 2.Anesthesia, Critical Care, and Pain MedicineMassachusetts General HospitalBostonUSA
  3. 3.Plastic and Reconstructive SurgeryMassachusetts General HospitalBostonUSA

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