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Better pain control for mastectomy patients?

Intraoperative local infiltration with liposomal bupivacaine provided better postoperative pain and nausea control than preoperative ultrasound-guided paravertebral block in patients undergoing mastectomy with immediate tissue expander reconstruction. That's according to researchers of a new study who report lower pain scores, opioid needs and antiemetic use in patients receiving liposomal bupivacaine.

Mayo Clinic researchers retrospectively reviewed 97 patients who underwent unilateral or bilateral mastectomy, with immediate tissue expander reconstruction, between May 2012 and October 2014. Of those, 52 patients had liposomal bupivacaine; the rest had paravertebral blocks.

The study, which researchers presented last May at the Plastic Surgery Research Council’s annual meeting in Seattle, Wash., shows opioid use in the recovery room was a mean 9.1 morphine equivalents in the liposomal bupivacaine group, compared to a mean 24.2 morphine equivalents among those receiving paravertebral blocks. Twelve patients in the liposomal bupivacaine group and 19 in the Paravertebral block group required antiemetic medication the day after surgery. Pain scores the day of surgery were a mean 3.3 for patients receiving liposomal bupivacaine versus 4.1 in the other group.

What This Means for Patients 

 

What This Means for Patients

Study author and Mayo Clinic, Rochester, breast surgeon Judy Boughey, M.D., says the study’s findings are important because immediate tissue expander breast reconstruction is associated with significant postoperative pain, nausea and vomiting.

“Although local anesthetics have long been used for postsurgical pain management, their duration of action is short. A significant amount of research has focused on extending the duration of action of local anesthetics to provide better opioid sparing postsurgical pain relief, both by use of regional blocks (such as paravertebral blocks) and by different forms of local anesthetic (such as liposomal bupivacaine),” Dr. Boughey tells Cosmetic Surgery Times.

Plastic surgeons can provide extended analgesia with local infiltration of liposomal bupivacaine into the surgical site at time of mastectomy with immediate tissue expander reconstruction.

“Our experience comparing intraoperative local infiltration of liposomal bupivacaine with preoperative ultrasound-guided paravertebral block shows that both modalities provide similar perioperative pain control. Therefore, plastic surgeons at institutions where preoperative paravertebral blocks are not available can now provide similar perioperative pain control by using liposomal bupivacaine. Additionally, institutions who routinely use preoperative paravertebral blocks may consider the option of using intraoperative liposomal bupivacaine infiltration instead,” Dr. Boughey says.

Dr. Boughey and colleagues have not found drawbacks associated with using liposomal bupivacaine.

“Our retrospective data revealed no drawbacks of using liposomal bupivacaine in 53 patients undergoing this procedure. The needle tip used to infiltrate liposomal bupivacaine is blunt, and we have not reported any postoperative hematomas that might be directly attributed to the infiltration technique,” she says.

However, research is still needed, according to Dr. Boughey.

“We report on data from our early experience. It is a retrospective study and non-randomized; therefore, this does not provide level I evidence. Additional research would be welcomed,” she says. Intraoperative local infiltration with liposomal bupivacaine provided better postoperative pain and nausea control than preoperative ultrasound-guided paravertebral block in patients undergoing mastectomy with immediate tissue expander reconstruction. Researchers of a new study report lower pain scores, opioid needs and antiemetic use in patients receiving liposomal bupivacaine.

Mayo Clinic researchers retrospectively reviewed 97 patients who underwent unilateral or bilateral mastectomy, with immediate tissue expander reconstruction, between May 2012 and October 2014. Of those, 52 patients had liposomal bupivacaine; the rest had paravertebral blocks.

The study, which researchers presented last May at the Plastic Surgery Research Council’s annual meeting in Seattle, Wash., shows opioid use in the recovery room was a mean 9.1 morphine equivalents in the liposomal bupivacaine group, compared to a mean 24.2 morphine equivalents among those receiving paravertebral blocks. Twelve patients in the liposomal bupivacaine group and 19 in the Paravertebral block group required antiemetic medication the day after surgery. Pain scores the day of surgery were a mean 3.3 for patients receiving liposomal bupivacaine versus 4.1 in the other group.

Study author and Mayo Clinic, Rochester, breast surgeon Judy Boughey, M.D., says the study’s findings are important because immediate tissue expander breast reconstruction is associated with significant postoperative pain, nausea and vomiting.

“Although local anesthetics have long been used for postsurgical pain management, their duration of action is short. A significant amount of research has focused on extending the duration of action of local anesthetics to provide better opioid sparing postsurgical pain relief, both by use of regional blocks (such as paravertebral blocks) and by different forms of local anesthetic (such as liposomal bupivacaine),” Dr. Boughey tells Cosmetic Surgery Times.

Plastic surgeons can provide extended analgesia with local infiltration of liposomal bupivacaine into the surgical site at time of mastectomy with immediate tissue expander reconstruction.

“Our experience comparing intraoperative local infiltration of liposomal bupivacaine with preoperative ultrasound-guided paravertebral block shows that both modalities provide similar perioperative pain control. Therefore, plastic surgeons at institutions where preoperative paravertebral blocks are not available can now provide similar perioperative pain control by using liposomal bupivacaine. Additionally, institutions who routinely use preoperative paravertebral blocks may consider the option of using intraoperative liposomal bupivacaine infiltration instead,” Dr. Boughey says.

Dr. Boughey and colleagues have not found drawbacks associated with using liposomal bupivacaine.

“Our retrospective data revealed no drawbacks of using liposomal bupivacaine in 53 patients undergoing this procedure. The needle tip used to infiltrate liposomal bupivacaine is blunt, and we have not reported any postoperative hematomas that might be directly attributed to the infiltration technique,” she says.

However, research is still needed, according to Dr. Boughey.

“We report on data from our early experience. It is a retrospective study and non-randomized; therefore, this does not provide level I evidence. Additional research would be welcomed,” she says. 

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