Postoperative pain, nausea, and vomiting cause stress and may worsen outcomes in the surgical patient. As breast reduction operations are increasingly being performed on an outpatient basis, reducing these problems is paramount. The use of a preoperative paravertebral block (PVB) has been shown to reduce opioid use and postoperative nausea and vomiting (PONV) in many surgical populations, but its role in breast reduction remains less clear.
To evaluate the safety and effectiveness of PVB as an adjunct to general anesthesia (GA) for breast reduction surgery.
After IRB approval, the electronic health records for patients who underwent breast reduction between 2011 and 2015 were reviewed. Patients were categorized into two groups by anesthesia modality: GA alone and GA plus PVB. Demographic information, opioid requirements, Phase I and II pain scores, the presence of PONV, and anesthesia time were collected and analyzed. Statistical analysis was performed using t-tests and Fisher’s exact test, and a p-value of ≤ 0.05 was deemed statistically significant.
264 patients who underwent breast reduction were identified. Of these, 209 (79%) received GA alone and 55 (21%) received GA + PVB. Intraoperative opioid requirements were lower for those receiving PVB compared to GA alone (mean morphine equivalent doses of 44mg vs 35mg, p < 0.019), though there was no difference in postoperative opioid requirements (mean doses of 30mg vs 29mg, p > 0.915). Phase I pain scores were significantly lower for those receiving PVB (2.9 vs 3.9, p < 0.012), and Phase II scores were significantly lower as well (3.0 vs 4.2, p < 0.001). PVB was associated with considerably less PONV (14% vs 33%, p < 0.007), but also higher mean anesthesia time compared to GA alone (271 minutes vs 236 minutes, p < 0.05). There were no anesthetic complications in the PVB group, nor were there any complications attributable to PVB.
By mitigating factors known to be associated with unplanned hospital admission and poor patient satisfaction, paravertebral regional blockade is an attractive anesthetic adjunct to breast surgery, particularly in the ambulatory setting. However, further investigation is needed, particularly to evaluate whether PVB meaningfully affects postoperative opioid usage.