Non-narcotic perioperative pain management in prosthetic breast reconstruction during an opioid crisis: A systematic review of paravertebral blocks Journal Article


Authors: Tokita, H. K.; Polanco, T. O.; Shamsunder, M. G.; Dabic, S.; Patel, V. G.; Allen, R. J. Jr; Dayan, J. H.; Mehrara, B. J.; Matros, E.; Nelson, J. A.
Article Title: Non-narcotic perioperative pain management in prosthetic breast reconstruction during an opioid crisis: A systematic review of paravertebral blocks
Abstract: Background: Alternatives to postoperative, narcotic pain management following implant-based, postmastectomy breast reconstruction (IBR) must be a focus for plastic surgeons and anesthesiologists, especially with the current opioid epidemic. Paravertebral blocks (PVBs) are a regional technique that has demonstrated efficacy in patients undergoing a variety of breast cancer-related surgeries. However, a specific understanding of PVB's efficacy in pain management in patients who undergo IBR is lacking. Methods: A systematic search of PubMed, EMBASE, and Cochrane Library electronic database was conducted to examine PVB administration in mastectomy patients undergoing IBR. Data were abstracted regarding: authors, publication year, study design, patient demographics, tumor laterality, tumor stage, type, and timing of reconstruction. The primary outcome was PVB efficacy, represented as patient-reported pain scores. Secondary outcomes of interest include narcotic consumption, postoperative nausea and vomiting, antiemetic use, and length of stay. Results: The search resulted in 1,516 unique articles. After title and abstract screening, 29 articles met the inclusion criteria for full-text review. Only 7 studies were included. Of those, 2 studies were randomized control trials and 5 were retrospective cohort studies. Heterogeneity of included studies precluded a meta-analysis. Overall, PVB patients had improved pain control, and less opioid consumption. Conclusion: PVBs are a regional anesthesia technique which may aid in pain management in the breast reconstructive setting. Evidence suggests that PVBs aid in controlling acute postoperative pain, reduce opioid consumption, and improve patient length of stay. However, some conflicting findings demonstrate a need for continued research in this area of pain control.
Keywords: mastectomy; prevalence; surgery; postoperative pain; outcomes; united-states; risk-factors; immediate reconstruction; naive patients; persistent postsurgical pain
Journal Title: Plastic and Reconstructive Surgery-Global Open
Volume: 7
Issue: 6
ISSN: 2169-7574
Publisher: Lippincott Williams & Wilkins  
Date Published: 2019-06-01
Start Page: e2299
Language: English
ACCESSION: WOS:000474638700036
DOI: 10.1097/gox.0000000000002299
PROVIDER: wos
Notes: Source: Wos
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MSK Authors
  1. Babak Mehrara
    265 Mehrara
  2. Evan Matros
    80 Matros
  3. Joseph Henry Dayan
    19 Dayan
  4. Jonas Allan Nelson
    15 Nelson
  5. Hanae Tokita
    4 Tokita
  6. Stefan Dabic
    1 Dabic
  7. Vaidehi Patel
    1 Patel