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

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Author information

Authors and Affiliations

  1. Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA

    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

  2. Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA

    Anita T. Mohan MRCS, Nho V. Tran MD, Karim Bakri MBBS, Steven R. Jacobson MD, Valerie Lemaine MD & Michel Saint-Cyr MD

  3. Department of Anesthesia, Mayo Clinic, Rochester, MN, USA

    Adam D. Niesen MD

  4. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    William S. Harmsen MSc

  5. Pharmacy Services, Mayo Clinic, Rochester, MN, USA

    Whitney Goede PharmD

Authors
  1. Jad M. Abdelsattar MBBS
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  2. Judy C. Boughey MD
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  3. Aodhnait S. Fahy BMBCh, PhD
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  4. James W. Jakub MD
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  5. David R. Farley MD
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  6. Tina J. Hieken MD
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  7. Amy C. Degnim MD
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  8. Whitney Goede PharmD
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  9. Anita T. Mohan MRCS
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  10. William S. Harmsen MSc
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  11. Adam D. Niesen MD
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  12. Nho V. Tran MD
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  13. Karim Bakri MBBS
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  14. Steven R. Jacobson MD
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  15. Valerie Lemaine MD
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  16. Michel Saint-Cyr MD
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Corresponding author

Correspondence to Judy C. Boughey MD.

Additional information

This study was approved by the Institutional Review Board (IRB) at Mayo Clinic, Rochester, MN.

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Abdelsattar, J.M., Boughey, J.C., Fahy, A.S. et al. Comparative Study of Liposomal Bupivacaine Versus Paravertebral Block for Pain Control Following Mastectomy with Immediate Tissue Expander Reconstruction. Ann Surg Oncol 23, 465–470 (2016). https://doi.org/10.1245/s10434-015-4833-4

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  • DOI: https://doi.org/10.1245/s10434-015-4833-4

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