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Ayyala HS, Assel M, Aloise J, Serafin J, Tan KS, Mehta M, Puttanniah V, McCormick P, Malhotra V, Vickers A, Matros E, Lin E. Paravertebral and erector spinae plane blocks decrease length of stay compared with local infiltration analgesia in autologous breast reconstruction. Reg Anesth Pain Med 2024:rapm-2023-105031. [PMID: 38336375 DOI: 10.1136/rapm-2023-105031] [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: 10/23/2023] [Accepted: 01/20/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Autologous breast reconstruction is associated with significant pain impeding early recovery. Our objective was to evaluate the impact of replacing surgeon-administered local infiltration with preoperative paravertebral (PVB) and erector spinae plane (ESP) blocks for latissimus dorsi myocutaneous flap reconstruction. METHODS Patients who underwent mastectomy with latissimus flap reconstruction from 2018 to 2022 were included in three groups: local infiltration, PVB, and ESP blocks. Block effect on postoperative length of stay (LOS) and the association between block status and pain, opioid consumption, time to first analgesic, and postoperative antiemetic administration were assessed. RESULTS 122 patients met the inclusion criteria for this retrospective cohort study: no block (n=72), PVB (n=26), and ESP (n=24). On adjusted analysis, those who received a PVB block had a 20-hour shorter postoperative stay (95% CI 11 to 30; p<0.001); those who received ESP had a 24-hour (95% CI 15 to 34; p<0.001) shorter postoperative stay compared with the no block group, respectively. Using either block was associated with a reduction in intraoperative opioids (23 morphine milligram equivalents (MME)), 95% CI 14 to 31, p<0.001; ESP versus no block: 23 MME, 95% CI 14 to 32, p<0.001). CONCLUSIONS Replacing surgical infiltration with PVB and ESP blocks for autologous breast reconstruction reduces LOS. The comparable reduction in LOS suggests that ESP may be a viable alternative to PVB in patients undergoing latissimus flap breast reconstruction following mastectomy. Further research should investigate whether ESP or PVB have better patient outcomes in complex breast reconstruction.
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Affiliation(s)
- Haripriya S Ayyala
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joseph Aloise
- Department of Operational Excellence, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joanna Serafin
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Meghana Mehta
- Digital Informatics & Technology Solutions Department, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vinay Puttanniah
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Patrick McCormick
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vivek Malhotra
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Evan Matros
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Emily Lin
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Bagaphou TC, Santonastaso DP, Cianchella M, Contine A, Valiani S, Bini V, Bruni C, Cerotto V, Ciabucchi C, Tiburzi C, Martinelli S, Cesari M. Erector Spinae Plane Block Versus Transversus Abdominis Plane Block for Postoperative Analgesia in Bariatric Surgery, Enhanced Recovery After Surgery Pathway. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Thierry Claude Bagaphou
- Section of Anesthesia, Intensive care and Pain Medicine, AUSL Umbria 1 Ospedale di Città di Castello, Città di Castello, Italy
| | | | - Michele Cianchella
- Section of Anesthesia, Intensive care and Pain Medicine, AUSL Umbria 1 Ospedale di Città di Castello, Città di Castello, Italy
| | - Alessandro Contine
- Department of General Surgery, USL Umbria1 Ospedale di Città di Castello, Città di Castello, Italy
| | - Saverio Valiani
- Department of General Surgery, USL Umbria1 Ospedale di Città di Castello, Città di Castello, Italy
| | - Vittorio Bini
- Internal Medicine, Endocrine and Metabolic Science Section, University of Perugia, Perugia Italy
| | - Carlo Bruni
- Section of Anesthesia, Intensive care and Pain Medicine, AUSL Umbria 1 Ospedale di Città di Castello, Città di Castello, Italy
| | - Vittorio Cerotto
- Section of Anesthesia, Intensive care and Pain Medicine, AUSL Umbria 1 Ospedale di Città di Castello, Città di Castello, Italy
| | - Chiara Ciabucchi
- Section of Anesthesia, Intensive care and Pain Medicine, AUSL Umbria 1 Ospedale di Città di Castello, Città di Castello, Italy
| | - Cinzia Tiburzi
- Section of Anesthesia, Intensive care and Pain Medicine, AUSL Umbria 1 Ospedale di Città di Castello, Città di Castello, Italy
| | - Stefano Martinelli
- Section of Anesthesia, Intensive care and Pain Medicine, AUSL Umbria 1 Ospedale di Città di Castello, Città di Castello, Italy
| | - Maurizio Cesari
- Department of General Surgery, USL Umbria1 Ospedale di Città di Castello, Città di Castello, Italy
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Practical Review of Abdominal and Breast Regional Analgesia for Plastic Surgeons: Evidence and Techniques. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3224. [PMID: 33425573 PMCID: PMC7787285 DOI: 10.1097/gox.0000000000003224] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/08/2020] [Indexed: 12/15/2022]
Abstract
Regional analgesia has been increasing in popularity due to its opioid- sparing analgesic effects and utility in multimodal analgesia strategies. Several regional techniques have been used in plastic surgery; however, there is a lack of consensus on the indications and the comparative efficacy of these blocks. The goal of this review is to provide evidence-based recommendations on the most relevant types of interfascial plane blocks for abdominal and breast surgery. A systematic search of the PUBMED, EMBASE, and Cochrane databases was performed to identify the evidence associated with the different interfascial plane blocks used in plastic surgery. The search included all studies from inception to March 2020. A total of 126 studies were included and used in the synthesis of the information presented in this review. There is strong evidence for using the transversus abdominis plane blocks in both abdominoplasties as well as abdominally-based microvascular breast reconstruction as evidenced by a significant reduction in post-operative pain and opioid consumption. Pectoralis (I and II), serratus anterior, and erector spinae plane blocks all provide good pain control in breast surgeries. Finally, the serratus anterior plane block can be used as primary block or an adjunct to the pectoralis blocks for a wider analgesia coverage of the breast. All the reviewed blocks are safe and easy to administer. Interfascial plane blocks are effective and safe modalities used to reduce pain and opioid consumption after abdominal and breast plastic surgery.
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Santonastaso DP, Cittadini A, De Chiara A, Russo E, Bagaphou CT, Agnoletti V. Erector spinae plane block for radical mastectomy: a different approach with the same good results. Minerva Anestesiol 2020; 86:1359-1360. [DOI: 10.23736/s0375-9393.20.14684-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Santonastaso DP, de Chiara A, Russo E, Tognù A, Martino C, Agnoletti V. Erector spinae plane block for pain control after bilateral embolization of uterine arteries: A new possible target. J Clin Anesth 2020; 68:110087. [PMID: 33032126 DOI: 10.1016/j.jclinane.2020.110087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/26/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Domenico P Santonastaso
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy.
| | - Annabella de Chiara
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy.
| | - Emanuele Russo
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy
| | - Andrea Tognù
- Section of Anesthesia and Intensive Care Unit, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy.
| | - Costanza Martino
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy.
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy.
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Yamane Y, Kosaka M, Akiizumi H, Kuroda M. Continuous erector spinae plane block for analgesia of sternum closure using a latissimus dorsi muscle flap for mediastinitis after coronary artery bypass grafting: a case report. JA Clin Rep 2020; 6:64. [PMID: 32813173 PMCID: PMC7438416 DOI: 10.1186/s40981-020-00370-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/11/2020] [Indexed: 12/03/2022] Open
Abstract
Background Erector spinae plane block (ESPB) is useful for providing analgesia after thoracic surgery. Previous reports show that ESPB is safely performed in patients receiving antithrombotic drugs. We effectively performed continuous ESPB in a patient receiving aspirin after coronary artery bypass grafting. Case presentation A 62-year-old man with mediastinitis was scheduled for sternum closure using a latissimus dorsi muscle flap. He had gone coronary artery bypass grafting and was taking aspirin. After induction of general anesthesia and tracheal intubation, a catheter was inserted for ESPB from the T6 level under ultrasound monitoring and infusion of ropivacaine was started. Tracheal tube was removed in the operating room, cold sense was absent between T2–8, and analgesia was between T3–T8 after uneventful surgery. There were no complications associated with ESPB postoperatively. Conclusion Continuous ESPB was a safe and useful analgesic method in a case undergoing sternum closure using a latissimus dorsi muscle flap.
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Affiliation(s)
- Yu Yamane
- Department of Anesthesiology, Hyogo Brain and Heart Center, 520 Saisho-Koh, Himeji, Hyogo, Japan.
| | - Masayuki Kosaka
- Department of Anesthesiology, Hyogo Brain and Heart Center, 520 Saisho-Koh, Himeji, Hyogo, Japan
| | - Haruki Akiizumi
- Department of Anesthesiology, Hyogo Brain and Heart Center, 520 Saisho-Koh, Himeji, Hyogo, Japan
| | - Mitsuo Kuroda
- Department of Anesthesiology, Hyogo Brain and Heart Center, 520 Saisho-Koh, Himeji, Hyogo, Japan
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Chin KJ, Adhikary SD, Forero M. Erector Spinae Plane (ESP) Block: a New Paradigm in Regional Anesthesia and Analgesia. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00333-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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