AI Article Synopsis
- - The study explored how different pain management techniques (thoracic epidural anesthesia, erector spinae plane block, and systemic analgesia) affect hospital stay length and opioid usage after mastectomy from 2014 to 2020.
- - Results showed that the erector spinae plane block led to the shortest hospital stay and required the least amount of opioids, while thoracic epidural anesthesia resulted in the longest stay and highest opioid use.
- - Overall, patients using the erector spinae plane block had higher chances of being discharged on postoperative day 1 compared to those receiving systemic analgesia or thoracic epidural anesthesia.
Article Abstract
Background: Adequate postoperative pain control is essential after mastectomy. This study compares the influence of 2 regional analgesia techniques on length of stay and opioid use to systemic analgesia alone.
Methods: Patients treated with mastectomy from 2014 to 2020 were stratified according to perioperative analgesic modality (systemic analgesia versus thoracic epidural anesthesia or erector spinae plane block). Demographic, tumor, and treatment characteristics were compared. Outcome variables included postoperative anesthesia unit and hospital length of stay, postoperative day 1 and 2 discharge rates, and inpatient opioid use (in oral milligram morphine equivalents).
Results: Of 316 patients, 171 received systemic analgesia, 72 thoracic epidural anesthesia, and 73 erector spinae plane block. On univariate analysis, there were significant differences in age, neoadjuvant chemotherapy, bilateral surgery, immediate reconstruction, and Her2 positivity rates. Thoracic epidural anesthesia had the longest hospital length of stay, and erector spinae plane block the shortest, compared with systemic analgesia (52.1 vs 28 vs 30.6 hours, P < .0001). Postoperative day 1 discharge was more likely with erector spinae plane block than systemic analgesia and less likely with thoracic epidural anesthesia (89% vs 68.4% vs 30.6%, P < .0001). Erector spinae plane block required significantly less milligram morphine equivalents than thoracic epidural anesthesia or systemic analgesia on postoperative day 1 (10 vs 18.75 vs 20 milligram morphine equivalents, P < .0009), but no differences on postoperative day 2 (23.5 vs 20 vs 25 milligram morphine equivalents, P = .84). Total hospital opioid use was significantly lower for erector spinae plane block than thoracic epidural anesthesia or systemic analgesia (24 vs 32.3 vs 32 milligram morphine equivalents, P = .024). On multivariate analysis, thoracic epidural anesthesia was associated with significantly longer length of stay, whereas neither thoracic epidural anesthesia nor erector spinae plane block was associated with decreased opioid use.
Conclusion: Regional analgesia is not significantly associated with decreased opioid use or hospital length of stay.
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| http://dx.doi.org/10.1016/j.surg.2024.08.055 | DOI Listing |
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