Postoperative Outcomes among Patients Who Receive Interpectoral Nerve Block during Mastectomy
Kara Kennedy, BA, Ricardo J. Bello, MD, Lauren Cournoyer, MD, David Meyer, MD, Kate Dinh, MD, Jennifer LaFemina, MD
Department of Surgery, University of Massachusetts Medical School, Worcester, MA
Background: The opioid epidemic highlights the need to maximize nonopioid options in the perioperative setting. Interpectoral nerve blocks (IPNB) have been used during mastectomy with limited evidence on effectiveness. We aim to determine the effectiveness of IPNB in postoperative opioid use, length-of-stay (LOS), and pain after mastectomy.
Methods: We retrospectively reviewed records of women who underwent mastectomy for cancer without immediate reconstruction from 10/17-12/19, extracting data on admission morphine milligram equivalents (MME), LOS, and pain scores. Wilcoxon rank sum was used for unadjusted analysis; multiple linear regression was used to adjust for confounding.
Results: 105 patients met inclusion criteria; 35% (n=37) received IPNB. MME use was significantly lower with IPNB (median 5; IQR 0 to 19) compared to controls (median 17; IQR 4 to 34; p=0.030). Although LOS and reported postoperative pain scores were lower with IPNB at 0-6 hr and 6-12 hr (62% and 25% reductions), these differences did not achieve significance (Table 1). There were no IPNB-related complications.
Conclusion: Our early experience shows reduced MME, LOS, and postoperative pain scores in patients who receive IPNB. Though we could not confirm that the results were significantly different, review suggests the need for analysis of a larger population to detect small differences can be considered along with evaluation into variations in medication type, dose, and timing before abandoning IPNB as an adjunct for pain control.
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