Enhanced Recovery With Paravertebral and Transversus Abdominis Plane Blocks in Microvascular Breast Reconstruction.

IF 1.8 Q3 ONCOLOGY Breast Cancer : Basic and Clinical Research Pub Date : 2020-10-21 eCollection Date: 2020-01-01 DOI:10.1177/1178223420967365
Ryan Guffey, Grace Keane, Austin Y Ha, Rajiv Parikh, Elizabeth Odom, Li Zhang, Terence M Myckatyn
{"title":"Enhanced Recovery With Paravertebral and Transversus Abdominis Plane Blocks in Microvascular Breast Reconstruction.","authors":"Ryan Guffey,&nbsp;Grace Keane,&nbsp;Austin Y Ha,&nbsp;Rajiv Parikh,&nbsp;Elizabeth Odom,&nbsp;Li Zhang,&nbsp;Terence M Myckatyn","doi":"10.1177/1178223420967365","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>We have shown previously that a preoperative paravertebral nerve block is associated with improved postoperative recovery in microvascular breast reconstruction. The purpose of this study was to compare the outcomes of a complete enhanced recovery after surgery (ERAS) protocol with complete regional anesthesia coverage to our traditional care with paravertebral block.</p><p><strong>Patients and methods: </strong>This was a retrospective cohort study of 83 patients who underwent autologous breast reconstruction by T.M.M. between May 2014 and February 2018 at a tertiary academic center. Patients in the ERAS group were additionally administered acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), gabapentin, a transversus abdominis plane block (liposomal or plain bupivacaine), and primarily oral opioids postoperatively. The patients were mobilized earlier with more rapid diet progression. All patients received a preoperative paravertebral block.</p><p><strong>Results: </strong>Forty-four patients in the ERAS cohort were compared with 39 retrospective controls. The 2 groups were similar with respect to demographics and comorbidities. The ERAS cohort required significantly less opioids (291 vs 707 mg oral morphine equivalent, <i>P</i> < .0001) with unchanged postoperative pain scores and a shorter time to oral only opioid use (16.0 vs 78.2 hours, <i>P</i> < .0001). Median length of stay (3.20 vs 4.62, <i>P</i> < .0001) and time to independent ambulation (1.86 vs 2.88, <i>P</i> < .0001) were also significantly decreased in the ERAS cohort. Liposomal bupivacaine use did not significantly affect the results (<i>P</i> ⩾ .2).</p><p><strong>Conclusions: </strong>Implementation of a robust enhanced recovery protocol with complete regional anesthesia coverage was associated with significantly decreased opioid use despite unchanged pain scores, with improved markers of recovery including length of stay, time to oral only narcotics, and time to independent ambulation.</p>","PeriodicalId":9163,"journal":{"name":"Breast Cancer : Basic and Clinical Research","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1178223420967365","citationCount":"4","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Breast Cancer : Basic and Clinical Research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/1178223420967365","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2020/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 4

Abstract

Purpose: We have shown previously that a preoperative paravertebral nerve block is associated with improved postoperative recovery in microvascular breast reconstruction. The purpose of this study was to compare the outcomes of a complete enhanced recovery after surgery (ERAS) protocol with complete regional anesthesia coverage to our traditional care with paravertebral block.

Patients and methods: This was a retrospective cohort study of 83 patients who underwent autologous breast reconstruction by T.M.M. between May 2014 and February 2018 at a tertiary academic center. Patients in the ERAS group were additionally administered acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), gabapentin, a transversus abdominis plane block (liposomal or plain bupivacaine), and primarily oral opioids postoperatively. The patients were mobilized earlier with more rapid diet progression. All patients received a preoperative paravertebral block.

Results: Forty-four patients in the ERAS cohort were compared with 39 retrospective controls. The 2 groups were similar with respect to demographics and comorbidities. The ERAS cohort required significantly less opioids (291 vs 707 mg oral morphine equivalent, P < .0001) with unchanged postoperative pain scores and a shorter time to oral only opioid use (16.0 vs 78.2 hours, P < .0001). Median length of stay (3.20 vs 4.62, P < .0001) and time to independent ambulation (1.86 vs 2.88, P < .0001) were also significantly decreased in the ERAS cohort. Liposomal bupivacaine use did not significantly affect the results (P ⩾ .2).

Conclusions: Implementation of a robust enhanced recovery protocol with complete regional anesthesia coverage was associated with significantly decreased opioid use despite unchanged pain scores, with improved markers of recovery including length of stay, time to oral only narcotics, and time to independent ambulation.

Abstract Image

Abstract Image

Abstract Image

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
椎旁和腹横平面阻滞在微血管乳房重建中的增强恢复。
目的:我们之前已经表明,术前椎旁神经阻滞与微血管乳房重建术后恢复的改善有关。本研究的目的是比较具有完全区域麻醉覆盖的手术后完全增强恢复(ERAS)方案与我们传统的椎旁阻滞治疗的结果。患者和方法:这是一项回顾性队列研究,纳入了2014年5月至2018年2月在某三级学术中心接受tmm自体乳房重建术的83例患者。ERAS组患者术后额外给予对乙酰氨基酚、非甾体抗炎药(NSAIDs)、加巴喷丁、经腹平面阻滞(脂质体或普通布比卡因)和主要口服阿片类药物。患者活动更早,饮食进展更快。所有患者术前均接受椎旁阻滞。结果:44例ERAS队列患者与39例回顾性对照进行了比较。两组在人口统计学和合并症方面相似。ERAS队列需要明显更少的阿片类药物(291 vs 707 mg口服吗啡当量,P P P P P小于0.2)。结论:尽管疼痛评分不变,但实施具有完全区域麻醉覆盖的强大增强恢复方案可显著减少阿片类药物的使用,改善恢复指标,包括住院时间、仅口服麻醉剂的时间和独立行走的时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
CiteScore
5.10
自引率
3.40%
发文量
22
审稿时长
8 weeks
期刊介绍: Breast Cancer: Basic and Clinical Research is an international, open access, peer-reviewed, journal which considers manuscripts on all areas of breast cancer research and treatment. We welcome original research, short notes, case studies and review articles related to breast cancer-related research. Specific areas of interest include, but are not limited to, breast cancer sub types, pathobiology, metastasis, genetics and epigenetics, mammary gland biology, breast cancer models, prevention, detection, therapy and clinical interventions, and epidemiology and population genetics.
期刊最新文献
Multicenter Prospective Study in HER2-Positive Early Breast Cancer for Detecting Minimal Residual Disease by Circulating Tumor DNA Analysis With Neoadjuvant Chemotherapy: HARMONY Study. ENO1 as a Biomarker of Breast Cancer Progression and Metastasis: A Bioinformatic Approach Using Available Databases. Quality of Life in Female Breast Cancer Patients and Survivors in a South African Municipality. Serum and Fecal Metabolite Profiles Linking With Gut Microbiome in Triple-Negative Breast Cancer Patients. Higher 10-Year Survival with Breast-Conserving Therapy over Mastectomy for Women with Early-Stage (I-II) Breast Cancer: Analysis of the CDC Patterns of Care Data Base.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1