Archives of Plastic Surgery

  • 제48권4호
  • /
  • Pages.361-365
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  • 2021
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  • 2234-6163(pISSN)
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  • 2234-6171(eISSN)
대한성형외과학회 (Korean Society of Plastic and Reconstructive Surgeons)
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Reducing pain and opioid consumption after body contouring of the breast by application of a perioperative nerve block: a systematic review

  • Asserson, Derek B. (California Northstate University College of Medicine) ;
  • Sahar, David E. (Division of Plastic Surgery, Department of Surgery, University of California Davis Medical Center)
  • 투고 : 2020.07.17
  • 심사 : 2021.05.25
  • 발행 : 2021.07.15
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초록

Background Pain in the postoperative body contouring patient has traditionally been managed with narcotic medication. In an effort to minimize side effects and prevent addiction, plastic surgeons are searching for novel ways to provide adequate analgesia, one of which is nerve blocks. This study was conducted with a meta-analysis that evaluates the efficacy of these blocks for patients who undergo breast surgery. Methods A search of the PubMed/MEDLINE database for articles including the terms "post-operative analgesia" OR "postoperative pain management" AND "in plastic surgery" OR "in cosmetic surgery" OR "in elective surgery" in February 2019 generated five studies on elective breast augmentation and reduction mammoplasty that reported pain scores and quantities of opioids consumed. Independent samples t-tests, one-way analysis of variance, and a random effects model were implemented for evaluation. Results A total of 317 patients were identified as having undergone body contouring of the breast, about half of which received a nerve block. Pain scores on a 1-10 scale and opioid dose-equivalents were calculated. Those who were blocked had an average score of 2.40 compared to 3.64 for those who did not (P<0.001), and required an average of 5.20 less narcotic doses (P<0.001). Pain relief following subpectoral augmentation was best achieved with type-II blocks as opposed to type-I and type-II with serratus plane (P<0.001). Conclusions The opioid epidemic has extended to all surgical specialties. Implementation of a nerve block seems to be an efficacious and cost-effective mechanism to not only help with post-operative pain, but also lower the need for narcotics, especially in subpectoral augmentation.

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참고문헌

  1. Centers for Disease Control and Prevention (CDC). Understanding the epidemic [Internet]. Atlanta, GA: CDC; c2019 [cited 2019 Jul 13]. Available from: https://www.cdc.gov/drugoverdose/epidemic/index.html.
  2. Waljee JF, Li L, Brummett CM, et al. Iatrogenic opioid dependence in the United States: are surgeons the gatekeepers? Ann Surg 2017;265:728-30. https://doi.org/10.1097/SLA.0000000000001904
  3. Bicket MC, Long JJ, Pronovost PJ, et al. Prescription opioid analgesics commonly unused after surgery: a systematic review. JAMA Surg 2017;152:1066-71. https://doi.org/10.1001/jamasurg.2017.0831
  4. Ko JY, Tong VT, Haight SC, et al. Obstetrician-gynecologists' practice patterns related to opioid use during pregnancy and postpartum: United States, 2017. J Perinatol 2020;40:412-21. https://doi.org/10.1038/s41372-019-0535-2
  5. Prince LY, Mears SC, Watson JC, et al. Health literacy evaluation of opioid patient education materials for orthopaedic surgery. J Surg Orthop Adv 2019;28:232-36.
  6. Boyd C, Shew M, Penn J, et al. Postoperative opioid use and pain management following otologic and neurotologic surgery. Ann Otol Rhinol Laryngol 2020;129:175-80. https://doi.org/10.1177/0003489419883296
  7. Rose KR, Christie BM, Block LM, et al. Opioid prescribing and consumption patterns following outpatient plastic surgery procedures. Plast Reconstr Surg 2019;143:929-38. https://doi.org/10.1097/PRS.0000000000005351
  8. Cooter RD, Rudkin GE, Gardiner SE. Day case breast augmentation under paravertebral blockade: a prospective study of 100 consecutive patients. Aesthetic Plast Surg 2007; 31:666-73. https://doi.org/10.1007/s00266-006-0230-5
  9. Wallace MS, Wallace AM, Lee J, et al. Pain after breast surgery: a survey of 282 women. Pain 1996;66:195-205. https://doi.org/10.1016/0304-3959(96)03064-3
  10. Ma J, Liu W, Hunter A, et al. Performing meta-analysis with incomplete statistical information in clinical trials. BMC Med Res Methodol 2008;8:56. https://doi.org/10.1186/1471-2288-8-56
  11. Hidalgo DA, Pusic AL. The role of methocarbamol and intercostal nerve blocks for pain management in breast augmentation. Aesthet Surg J 2005;25:571-5. https://doi.org/10.1016/j.asj.2005.09.003
  12. Oksuz G, Bilgen F, Arslan M, et al. Ultrasound-guided bilateral erector spinae block versus tumescent anesthesia for postoperative analgesia in patients undergoing reduction mammoplasty: a randomized controlled study. Aesthetic Plast Surg 2019;43:291-6. https://doi.org/10.1007/s00266-018-1286-8
  13. Ekinci M, Ciftci B, Celik EC, et al. The efficacy of different volumes on ultrasound-guided type-I pectoral nerve block for postoperative analgesia after subpectoral breast augmentation: a prospective, randomized, controlled study. Aesthetic Plast Surg 2019;43:297-304. https://doi.org/10.1007/s00266-019-01322-8
  14. Karaca O, Pinar HU, Arpaci E, et al. The efficacy of ultrasound-guided type-I and type-II pectoral nerve blocks for postoperative analgesia after breast augmentation: a prospective, randomised study. Anaesth Crit Care Pain Med 2019; 38:47-52. https://doi.org/10.1016/j.accpm.2018.03.009
  15. Schuitemaker R JB, Sala-Blanch X, Sanchez Cohen AP, et al. Analgesic efficacy of modified pectoral block plus serratus plane block in breast augmentation surgery: a randomised, controlled, triple-blind clinical trial. Rev Esp Anestesiol Reanim (Engl Ed) 2019;66:62-71. https://doi.org/10.1016/j.redar.2018.08.001
  16. Morales R Jr, Mentz H 3rd, Newall G, et al. Use of abdominal field block injections with liposomal bupivicaine to control postoperative pain after abdominoplasty. Aesthet Surg J 2013;33:1148-53. https://doi.org/10.1177/1090820X13510720
  17. Kennedy GT, Hill CM, Huang Y, et al. Enhanced recovery after surgery (ERAS) protocol reduces perioperative narcotic requirement and length of stay in patients undergoing mastectomy with implant- based reconstruction. Am J Surg 2020;220:147-52. https://doi.org/10.1016/j.amjsurg.2019.10.007
  18. O'Neill RC, Hayes KD, Davison SP. Safety of postoperative opioid alternatives in plastic surgery: a systematic review. Plast Reconstr Surg 2019;144:991-9. https://doi.org/10.1097/PRS.0000000000006074
  19. Chavez-Abraham V, Barr JS, Zwiebel PC. The efficacy of a lidocaine-infused pain pump for postoperative analgesia following elective augmentation mammaplasty or abdominoplasty. Aesthetic Plast Surg 2011;35:463-9. https://doi.org/10.1007/s00266-010-9633-4