The purpose of this study is to determine the most effective way to control post-operative breast pain for patients undergoing a unilateral, immediate breast reconstruction.
This is a randomized controlled study to compare the effectiveness of a breast nerve block performed with bupivacaine as compared to liposomal bupivacaine in providing postsurgical analgesia in patients undergoing unilateral abdominally-based breast reconstruction at time of mastectomy. OBJECTIVES 1. Compare the amount of postoperative narcotic use in patients receiving a bupivacaine or liposomal bupivacaine pectoralis and serratus anterior nerve block. Compare these groups to a retrospective control cohort who received local anesthetic infusion but did not receive any nerve block. 2. Examine the incidence of narcotic-related side effects in the experimental groups by documenting incidents of nausea and vomiting, time to first ambulation, liquid and solid oral intake. 3. Survey patient satisfaction with pain management using a visual analog scale during their hospital stay.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
20mL vial of Liposomal Bupivacaine (266 mg). The infiltration technique for Liposomal Bupivacaine will be 80mL injected into either hemi-abdomen as a transversus abdominous plane (TAP) block via ultrasound guidance. The other 80mL will be utilized in the operative breast for the field blocks (20mL), pectoralis 1 (20mL), pectoralis 2 (20mL) and serratus anterior (20mL) blocks.
20mL vial of 0.25% Bupivacaine. The field blocks (20mL), pectoralis 1 (20mL), pectoralis 2 (20mL) and serratus anterior (20mL) blocks will be performed with 0.25% Bupivacaine.
The patient-controlled anesthesia will be filled with morphine or hydromorphone. Pumps will be programmed be on demand only with no basal rate.
total post-operative narcotic utilization
post-operative pain as measured by total post-operative narcotic utilization standardized to milligrams of morphine.
Time frame: Up to 72 hours post-operative
at rest pain score on visual analog scale
0-100 score of self-reported pain
Time frame: Up to 72 hours post-operative
coughing pain score on visual analog scale
0-100 score of self-reported pain
Time frame: Up to 72 hours post-operative
number of incidents of nausea reported by patient
self-report of nausea
Time frame: Up to 72 hours post-operative
number of incidents of vomiting reported by patient
number of times a patient vomits
Time frame: Up to 72 hours post-operative
time to first ambulation
Time frame: Up to 72 hours post-operative
time to first liquid intake
Time frame: Up to 72 hours post-operative
time to first solid intake
Time frame: Up to 72 hours post-operative
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Oral narcotics will be offered when the patient's diet is advanced as tolerated, typically post-operative day 1.