SHORT TERM OUTCOMES OF A COMPARATIVE ANALYSIS BETWEEN LOCAL ANESTHETIC WOUND INFILTRATION AND REGIONAL ANESTHESIA IN BREAST SURGERY: SHOULD WE OPT FOR A SELECTIVE APPROACH?

Abstract

Background: Full short-term effects of regional anesthesia in breast surgery is not well known. We aimed to assess any differences in the short-term outcomes of regional block and local anesthetic (LA) wound inltration in breast surgery. Materials and methods: A prospective non-randomized observational study of elective breast surgical procedures between 01/06/2018 and 28/02/3019 was performed at a district general hospital in the North-West England. Data comprised of patientand procedure-specic demographics, relevant health conditions, pain scale, blood pressure, analgesia requirement, Postoperative Nausea and Vomiting (PONV) score and Length of stay (LoS). Operations were classed as minor/ moderate and major. Regional anesthesia (RA) comprised of paravertebral, intercostal, pectoral and serratus blocks. Results: A total of 143 events (regional anesthesia, n=58; LA wound inltration, n=85) were analysed. Reduced pain score and longer anesthetic time were noted in the regional anesthesia group (p<0.001). A trend of reduced strong opioid requirement was also noted in the major procedure group receiving regional anesthesia. PONV scale was higher in the major surgery groups, signicantly so in the LA group (p<0.001). No signicant association was noted with various past medical histories, and LoS. A signicant increase in occurrence of wound-site haematoma (5.6%) along with per-operative hypotension was noted in the paravertebral block group. Levo-Bupivacaine was associated with least overall opioid requirement (p=0.01). Conclusions: A selective approach to provide regional anesthesia using Levo-Bupivacaine in major breast cases, irrespective of common health conditions, would likely to result in reduced pain score and opioid requirements, and offset the longer anesthetic time. Association between haematoma formation and paravertebral block merits further larger study. Plain Language Summary Ÿ Regional anesthesia in breast surgery warrants specialist skill, extra time and has potential side effects as well as benets. Ÿ Short term benets of regional anesthesia in breast surgery were assessed in this non-randomized study in comparison to traditional local anesthetic wound inltration. Ÿ Most benets, in terms of improved pain score and reduced morphine requirements, were noted in association with regional anesthesia using Levo-Bupivacaine in major breast cases. This would allow a selective approach whilst planning for most effective anesthetic and analgesic effect in breast surgery. Ÿ Higher occurrence of post-operative wound haematoma was noted mostly in association with paravertebral block, the particular type of regional anesthesia where drop of blood pressure was also signicant. Further study would help clarify the signicance of these ndings.