Paravertebral and erector spinae plane blocks decrease length of stay compared with local infiltration analgesia in autologous breast reconstruction Journal Article
| Authors: | Ayyala, H. S.; Assel, M.; Aloise, J.; Serafin, J.; Tan, K. S.; Mehta, M.; Puttanniah, V.; McCormick, P.; Malhotra, V.; Vickers, A.; Matros, E.; Lin, E. |
| Article Title: | Paravertebral and erector spinae plane blocks decrease length of stay compared with local infiltration analgesia in autologous breast reconstruction |
| 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. © American Society of Regional Anesthesia & Pain Medicine 2025. No commercial re-use. See rights and permissions. Published by BMJ Group. |
| Keywords: | adult; controlled study; treatment outcome; aged; middle aged; retrospective studies; major clinical study; comparative study; postoperative care; mastectomy; midazolam; opiate; sedation; cohort analysis; dexamethasone; breast reconstruction; mammaplasty; latissimus dorsi flap; retrospective study; length of stay; narcotic analgesic agent; preoperative period; diagnosis; antiemetic agent; morphine; drug dose titration; analgesics, opioid; anesthetics, local; observational study; bupivacaine; analgesia; postoperative pain; pain, postoperative; innervation; sodium chloride; pain management; prevention and control; fentanyl; local anesthetic agent; nerve block; anesthesia, local; etiology; adverse event; clonidine; comparative effectiveness; local anesthesia; procedures; spinal anesthesia; acute pain; postoperative nausea and vomiting; intercostal nerve block; patient comfort; humans; human; female; article; evaluation study; ropivacaine; autologous breast reconstruction; paraspinal muscle; erector spinae muscle; paraspinal muscles; superficial back muscles; local infiltration analgesia; back muscle |
| Journal Title: | Regional Anesthesia and Pain Medicine |
| Volume: | 50 |
| Issue: | 4 |
| ISSN: | 1098-7339 |
| Publisher: | BMJ Publishing Group Ltd. |
| Date Published: | 2025-04-01 |
| Start Page: | 339 |
| End Page: | 344 |
| Language: | English |
| DOI: | 10.1136/rapm-2023-105031 |
| PUBMED: | 38336375 |
| PROVIDER: | scopus |
| PMCID: | PMC11306410 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Emily Lin -- Source: Scopus |
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