Non-narcotic Perioperative Pain Management in Prosthetic Breast Reconstruction During an Opioid Crisis: A Systematic Review of Paravertebral Blocks.

摘要: Background Alternatives to postoperative, narcotic pain management following implant-based, postmastectomy breast reconstruction (IBR) must be a focus for plastic surgeons and anesthesiologists, especially with the current opioid epidemic. Paravertebral blocks (PVBs) are regional technique that has demonstrated efficacy in patients undergoing variety of cancer-related surgeries. However, specific understanding PVB's who undergo IBR is lacking. Methods A systematic search PubMed, EMBASE, Cochrane Library electronic database was conducted examine PVB administration mastectomy IBR. Data were abstracted regarding: authors, publication year, study design, patient demographics, tumor laterality, stage, type, timing reconstruction. The primary outcome efficacy, represented as patient-reported scores. Secondary outcomes interest include consumption, postoperative nausea vomiting, antiemetic use, length stay. Results resulted 1,516 unique articles. After title abstract screening, 29 articles met inclusion criteria full-text review. Only 7 studies included. Of those, 2 randomized control trials 5 retrospective cohort studies. Heterogeneity included precluded meta-analysis. Overall, had improved control, less consumption. Conclusion PVBs anesthesia which may aid reconstructive setting. Evidence suggests controlling acute pain, reduce improve some conflicting findings demonstrate need continued research this area control.