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.

DOI Link

Study Purpose

To compare the effects of local infiltration of bupivacaine with nerve block for pain control with mastectomy

Intervention Characteristics/Basic Study Process

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.

Sample Characteristics

  • N = 97   
  • FEMALES: 100%
  • CURRENT TREATMENT: Other
  • KEY DISEASE CHARACTERISTICS: All had breast cancer 
  • OTHER KEY SAMPLE CHARACTERISTICS: The majority had unilateral mastectomy with no ALND.  There was no difference between groups in intraoperative time or recovery room time.

Setting

  • SITE: Single site   
  • SETTING TYPE: Inpatient    
  • LOCATION: Mayo Clinic, Rochester

Phase of Care and Clinical Applications

PHASE OF CARE: Active anti-tumor treatment

Study Design

Retrospective cohort analysis

Measurement Instruments/Methods

  • Pain score on numeric scale 
  • Time to first opioid postoperatively
  • Antiemetic use on day 1

Results

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.

Conclusions

Local infusion of bupivacaine appeared to be more effective that paravertebral block for postoperative pain control in this group of patients.

Limitations

  • Small sample (< 100)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)

 

Nursing Implications

Nurses can advocate for consideration of local anesthetic infiltration for pain control in patients undergoing mastectomy.