Improving postoperative pain management in subpectoral tissue expander implant reconstruction of the breast using an elastomeric pump.
BACKGROUND
Postoperative pain after breast surgery is one of the major factors contributing to delay in mobilisation and prolonged hospital stay. A retrospective analysis was performed of patients undergoing skin sparing mastectomy and insertion of a subpectoral implant. The aim was to determine whether the use of an elastomeric local anaesthetic pump improved pain control and length of stay.


METHODS
Twenty-five consecutive patients undergoing the above procedure were sited with an elastomeric local anaesthetic infusion pump intraoperatively, in addition to standard regular and pro re nata analgesia. The control group comprised 25 patients undergoing the same procedure in the same year who received standard analgesia alone. Visual analogue scale scores were recorded for the duration of inpatient stay, as was any further analgesic requirement.


RESULTS
The median age was 51 years (range: 26-75 years) in the intervention group and 50 years (range: 28-70 years) in the control group. The mean visual analogue scale score was 0.28 (standard deviation [SD]: 0.61) at 24 hours for the intervention group and 1.84 (SD: 0.37) for the control group (p<0.0001). The mean length of stay was 1.8 days (SD: 0.71 days) for the intervention group and 2.28 days (SD: 0.94 days) for the control group (p=0.15). There were no complications involving catheter placement, leakage or toxicity relating to use of the local anaesthetic.


CONCLUSIONS
There was significantly reduced pain with the use of the local anaesthetic infusion pump. The elastomeric pump is a step towards enhanced patient recovery after breast surgery in the case of skin sparing mastectomy and subpectoral tissue expander reconstruction.
Great Western Hospitals NHS Foundation Trust , UK.
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A
Chaudhry
North Bristol NHS Trust , UK.
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S
Hallam
North Bristol NHS Trust , UK.
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A
Chambers
North Bristol NHS Trust , UK.
A K
AK
Sahu
North Bristol NHS Trust , UK.
S
S
Govindarajulu
North Bristol NHS Trust , UK.
S
S
Cawthorn
D000328:Adult; D000368:Aged; D001940:Breast / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D015625:Tissue Expansion Devices
Breast neoplasms; Breast reconstruction; Pain