Intrathecal Morphine Versus Paravertebral Nerve Blocks for Analgesia After Breast Reconstruction With Abdominally Based Free Flaps.

Abstract

Background: Breast reconstruction with abdominally based free flaps can be associated with more significant acute pain and longer hospital stays than implant-based techniques. As new pain management strategies are developed, there have not been any studies conducted to analyze intrathecal morphine's (ITM) analgesic effects for patients undergoing abdominally based free flap reconstruction.

Objectives: The primary outcome analyzed from this retrospective study was opioid consumption, which was measured from postoperative anesthesia care unit (PACU) through postoperative day (POD) 2. In addition, the secondary outcomes analyzed from the study included factors such as pain scores, hospital length of stay (LOS), and adverse effects.

Methods: 51 patients presented for breast reconstruction with abdominally based free flaps and received ITM for postoperative analgesia. Then, results obtained were compared with a cohort that included an equal number of patients who received paravertebral nerve blocks (PVBs).

Results: Results showed that patients who received ITM displayed a lower median consumption in PACU (0 mg versus 12.5 mg MEQ; p = 0.009), from PACU to POD 1 (0 mg versus 7.5 mg MEQ; p =0.046), and POD 1 to POD 2 (7.5 mg versus 30 mg MEQ; p = 0.002) when compared with those who received PVBs. Those who received ITM also had lower median pain scores in the PACU and from PACU to POD 1 and decreased LOS. There were similar rates of adverse events.

Conclusions: ITM improves postoperative analgesia after abdominally based free flaps compared to PVBs and may facilitate recovery and earlier discharge.