Opioid-sparing Strategies in Alloplastic Breast Reconstruction: A Systematic Review
Introduction:. Pain and discomfort are frequently experienced following mastectomy with concomitant breast implant- or tissue expander-based alloplastic breast reconstruction (AlBR). Unfortunately, postoperative opioids have decreased efficacy in AlBR, short-term complication profiles, and are fraug...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2021-11-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003932 |
| _version_ | 1818931508868546560 |
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| author | Dustin T. Crystal, MD Ahmed M. S. Ibrahim, MD, PhD Louise L. Blankensteijn, MD Nicholas G. Cuccolo, MD Darya Kazei, MD Helen S. Zitkovsky, BA Bernard T. Lee, MD, MPH, MBA Samuel J. Lin, MD, MBA |
| author_facet | Dustin T. Crystal, MD Ahmed M. S. Ibrahim, MD, PhD Louise L. Blankensteijn, MD Nicholas G. Cuccolo, MD Darya Kazei, MD Helen S. Zitkovsky, BA Bernard T. Lee, MD, MPH, MBA Samuel J. Lin, MD, MBA |
| author_sort | Dustin T. Crystal, MD |
| collection | DOAJ |
| description | Introduction:. Pain and discomfort are frequently experienced following mastectomy with concomitant breast implant- or tissue expander-based alloplastic breast reconstruction (AlBR). Unfortunately, postoperative opioids have decreased efficacy in AlBR, short-term complication profiles, and are fraught by long-term dependence. This systematic review aims to identify opioid-sparing pain management strategies in AlBR.
Methods:. A systematic literature search of MEDLINE, Embase, Web of Science, and Cochrane Central Register was performed in September 2018. PRISMA guidelines were followed, and the review was prospectively registered in PROSPERO (CRD42018107911). The search identified 1184 articles. Inclusion criteria were defined as patients 18 years or older undergoing AlBR.
Results:. Fourteen articles were identified assessing opioid-sparing strategies in AlBR. This literature included articles evaluating enhanced recovery protocols (two), intercostal blocks (two), paravertebral blocks (four), liposomal bupivacaine (three), diclofenac (one), and local anesthesia infusion pumps (two). The literature included five randomized trials and nine cohort studies. Study characteristics, bias (low to high risk), and reporting outcomes were extensively heterogeneous between articles. Qualitative analysis suggests reduced opioid utilization in enhanced recovery after surgery (ERAS) pathways, paravertebral blocks, and use of liposomal bupivacaine.
Conclusions:. A variety of opioid-sparing strategies are described for pain management in AlBR. Multimodal analgesia should be provided via ERAS pathways as they appear to reduce pain and spare opioid use. Targeted paravertebral blocks and liposomal bupivacaine field blocks appear to be beneficial in sparing opioids and should be considered as essential components of ERAS protocols. Additional prospective, randomized trials are necessary to delineate the efficacy of other studied modalities. |
| first_indexed | 2024-12-20T04:17:43Z |
| format | Article |
| id | doaj.art-74d7ca4ae4a04296aa21eef9db13a32c |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-12-20T04:17:43Z |
| publishDate | 2021-11-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-74d7ca4ae4a04296aa21eef9db13a32c2022-12-21T19:53:44ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742021-11-01911e393210.1097/GOX.0000000000003932202111000-00039Opioid-sparing Strategies in Alloplastic Breast Reconstruction: A Systematic ReviewDustin T. Crystal, MD0Ahmed M. S. Ibrahim, MD, PhD1Louise L. Blankensteijn, MD2Nicholas G. Cuccolo, MD3Darya Kazei, MD4Helen S. Zitkovsky, BA5Bernard T. Lee, MD, MPH, MBA6Samuel J. Lin, MD, MBA7From the * Division of Plastic Surgery, Hospital of the University of Pennsylvania, Perlman School of Medicine, Philadelphia, Pa.† Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.† Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.‡ Hansjörg Wyss Department of Plastic Surgery, NYU Langone, New York, N.Y.† Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.† Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.† Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.† Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.Introduction:. Pain and discomfort are frequently experienced following mastectomy with concomitant breast implant- or tissue expander-based alloplastic breast reconstruction (AlBR). Unfortunately, postoperative opioids have decreased efficacy in AlBR, short-term complication profiles, and are fraught by long-term dependence. This systematic review aims to identify opioid-sparing pain management strategies in AlBR. Methods:. A systematic literature search of MEDLINE, Embase, Web of Science, and Cochrane Central Register was performed in September 2018. PRISMA guidelines were followed, and the review was prospectively registered in PROSPERO (CRD42018107911). The search identified 1184 articles. Inclusion criteria were defined as patients 18 years or older undergoing AlBR. Results:. Fourteen articles were identified assessing opioid-sparing strategies in AlBR. This literature included articles evaluating enhanced recovery protocols (two), intercostal blocks (two), paravertebral blocks (four), liposomal bupivacaine (three), diclofenac (one), and local anesthesia infusion pumps (two). The literature included five randomized trials and nine cohort studies. Study characteristics, bias (low to high risk), and reporting outcomes were extensively heterogeneous between articles. Qualitative analysis suggests reduced opioid utilization in enhanced recovery after surgery (ERAS) pathways, paravertebral blocks, and use of liposomal bupivacaine. Conclusions:. A variety of opioid-sparing strategies are described for pain management in AlBR. Multimodal analgesia should be provided via ERAS pathways as they appear to reduce pain and spare opioid use. Targeted paravertebral blocks and liposomal bupivacaine field blocks appear to be beneficial in sparing opioids and should be considered as essential components of ERAS protocols. Additional prospective, randomized trials are necessary to delineate the efficacy of other studied modalities.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003932 |
| spellingShingle | Dustin T. Crystal, MD Ahmed M. S. Ibrahim, MD, PhD Louise L. Blankensteijn, MD Nicholas G. Cuccolo, MD Darya Kazei, MD Helen S. Zitkovsky, BA Bernard T. Lee, MD, MPH, MBA Samuel J. Lin, MD, MBA Opioid-sparing Strategies in Alloplastic Breast Reconstruction: A Systematic Review Plastic and Reconstructive Surgery, Global Open |
| title | Opioid-sparing Strategies in Alloplastic Breast Reconstruction: A Systematic Review |
| title_full | Opioid-sparing Strategies in Alloplastic Breast Reconstruction: A Systematic Review |
| title_fullStr | Opioid-sparing Strategies in Alloplastic Breast Reconstruction: A Systematic Review |
| title_full_unstemmed | Opioid-sparing Strategies in Alloplastic Breast Reconstruction: A Systematic Review |
| title_short | Opioid-sparing Strategies in Alloplastic Breast Reconstruction: A Systematic Review |
| title_sort | opioid sparing strategies in alloplastic breast reconstruction a systematic review |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003932 |
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