Abdelsattar, J.M., Boughey, J.C., Fahy, A.S., Jakub, J.W., Farley, D.R., Hieken, T.J., . . . Saint-Cyr, M. (2016). Comparative study of liposomal bupivacaine versus paravertebral block for pain control following mastectomy with immediate tissue expander reconstruction. Annals of Surgical Oncology, 23, 465–470.
To compare the effects of local infiltration of bupivacaine with nerve block for pain control with mastectomy
Electronic health records of all patients who had mastectomy with immediate tissue expander reconstruction were used for data collection. Pain scores from the recovery room and surgical units were obtained and average pain scores for postoperative days 1-2 were used in analysis. All opioids used intraoperatively and postoperatively were converted to oral morphine equivalents.
PHASE OF CARE: Active anti-tumor treatment
Retrospective cohort analysis
Opioid use in the recovery room was significantly lower in those who had local bupavacaine injection (p < 0.001). Day of surgery pain scores were lower with bupavacain (p = 0.008). Fewer patient in the bupavaine group required antiemetics (p = 0.03) and waited longer for the first dose of opioid after surgery (p = 0.006). Daily average pain was lower with bupivacaine (p = 0.05), and total opioid consumption was slightly lower.
Local infusion of bupivacaine appeared to be more effective that paravertebral block for postoperative pain control in this group of patients.
Nurses can advocate for consideration of local anesthetic infiltration for pain control in patients undergoing mastectomy.