title: Comparative Study of Liposomal Bupivacaine Versus Paravertebral Block for Pain Control Following Mastectomy with Immediate Tissue Expander Reconstruction.
abstract: BACKGROUND
  Several approaches to minimize postoperative pain, nausea, and enhance recovery are available for patients undergoing mastectomy with immediate tissue expander (TE) reconstruction. We compared the effectiveness of intraoperative local infiltration of liposomal bupivacaine (LB) to preoperative paravertebral block (PVB).
  
  
  METHODS
  We retrospectively reviewed patients who underwent mastectomy with immediate TE reconstruction between May 2012 and October 2014 and compared patients with preoperative ultrasound-guided PVB to those with intraoperative LB infiltration.
  
  
  RESULTS
  Fifty-three patients (54.6 %) received LB and 44 received PVB. LB was associated with less opioid use in the recovery room (p < 0.001), fewer patients requiring antiemetics (p = 0.03), and lower day of surgery pain scores (p = 0.008). LB also was associated with longer time to first opioid use (p = 0.04). On multivariable analysis controlling for expander placement location, year of surgery, and axillary lymph node dissection (ALND), the only variable that remained statistically significant was lower opioid use in the recovery room for patients with LB (p = 0.03) and day of surgery pain scores approached significance (p = 0.05). There was no difference in the proportion of patients discharged within 36 h of surgery between the groups. Focusing on first cases of the day (where PVBs are performed in the OR) showed average time to skin incision was 15 min shorter in the LB group (p = 0.004).
  
  
  CONCLUSIONS
  Local infiltration of LB in patients undergoing mastectomy with immediate TE reconstruction decreases narcotic requirements in the recovery room, shortens preoperative anesthesiology time, and provides similar, if not better, perioperative pain control compared with PVB.
authors: Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Jad M
authors: JM
authors: Abdelsattar
authors: Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA. Boughey.judy@mayo.edu.
authors: Judy C
authors: JC
authors: Boughey
authors: Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Aodhnait S
authors: AS
authors: Fahy
authors: Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
authors: James W
authors: JW
authors: Jakub
authors: Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
authors: David R
authors: DR
authors: Farley
authors: Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Tina J
authors: TJ
authors: Hieken
authors: Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Amy C
authors: AC
authors: Degnim
authors: Pharmacy Services, Mayo Clinic, Rochester, MN, USA.
authors: Whitney
authors: W
authors: Goede
authors: Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Anita T
authors: AT
authors: Mohan
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors: William S
authors: WS
authors: Harmsen
authors: Department of Anesthesia, Mayo Clinic, Rochester, MN, USA.
authors: Adam D
authors: AD
authors: Niesen
authors: Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Nho V
authors: NV
authors: Tran
authors: Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Karim
authors: K
authors: Bakri
authors: Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Steven R
authors: SR
authors: Jacobson
authors: Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Valerie
authors: V
authors: Lemaine
authors: Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Michel
authors: M
authors: Saint-Cyr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage; D018427:Breast Implants; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008081:Liposomes / Q000008:administration & dosage; D016462:Mammaplasty / Q000295:instrumentation / Q000379:methods*; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D009367:Neoplasm Staging; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management; D010149:Postoperative Pain / Q000517:prevention & control*; D011379:Prognosis; D012189:Retrospective Studies; D015625:Tissue Expansion Devices; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D008081:Liposomes; D002045:Bupivacaine