Background
The appropriate inclusion and use of regional anesthesia can result in better pain control and reduce overall costs for facilities. Currently, paravertebral nerve blocks remain one of the most common and technically challenging nerve blocks to perform. In recent years, the pectoral nerve blocks have been shown to be a more accessible regional anesthetic to perform in patients undergoing mastectomies. Several reports have also demonstrated superiority of pectoral blocks over the paravertebral approach in such patients. In 2015, Bashandy et al. reported a significant reduction in postoperative nausea and vomiting in 120 patients in Egypt who received intraoperative thoracic intercostal nerve blocks while undergoing implant-based breast reconstruction. In addition to an anticipated reduction in opiate requirements, Shah and colleagues also demonstrated cost savings of approximately $1,500 and $2,900 to patients at a single major academic center for unilateral and bilateral reconstructions with nerve blocks, respectively.
Study Description
A retrospective chart review was performed using the electronic medical records available at the UC Davis Medical Center (Sacramento, California) to search for patients having undergone unilateral or bilateral mastectomies between 2012 and 2016. Patients over the age of 18 years with planned unilateral or bilateral mastectomy without additional procedures, operations, and/or primary diagnoses directly unrelated to the mastectomy were included in the study. Qualifying patients were divided into two groups based on the laterality of the surgery as documented by the performing surgeon(s): unilateral or bilateral mastectomy. The patients were further subdivided based on whether pectoral blocks were performed or not, as determined by the anesthesia documentation in the medical records.
Discussion
A total of 43 patients received preoperative pectoral blocks at our institution with a significant reduction in both intraoperative (p<0.003) and postoperative opioid requirements over 24 hours for pain control (p<0.01), based on morphine milligram equivalents (MME) compared to 50 patients who did not receive preoperative pectoral blocks. Post-recovery opioid consumption after discharge from the PACU was not statistically significant between the two intervention and control group. Possible follow-up studies include larger retrospective studies for increased statistical power, prospective studies, and a retrospective study on potential impact on post mastectomy pain syndrome.
