PMID- 27847703
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200930
IS  - 2228-7523 (Print)
IS  - 2228-7531 (Electronic)
IS  - 2228-7523 (Linking)
VI  - 6
IP  - 5
DP  - 2016 Oct
TI  - Treatment of Post-Latissimus Dorsi Flap Breast Reconstruction Pain With 
      Continuous Paravertebral Nerve Blocks: A Retrospective Review.
PG  - e39476
LID - e39476
AB  - OBJECTIVES: The addition of a perioperative continuous paravertebral nerve block 
      (cPVB) to a single-injection thoracic paravertebral nerve block (tPVB) has 
      demonstrated improved analgesia in breast surgery. However, its use following 
      isolated post-mastectomy reconstruction using a latissimus dorsi flap (LDF) has 
      not previously been examined. METHODS: We performed a retrospective review of 
      patients who underwent salvage breast reconstruction with a unilateral LDF by a 
      single surgeon. Preoperatively, all patients received a single-injection tPVB 
      with 0.5% ropivacaine. Additionally, patients had the option for catheter 
      placement to receive a continuous 0.2% ropivacaine infusion with intermittent 
      boluses. Infusions commenced in the recovery room and the catheters were removed 
      on the morning of discharge. The primary endpoint was the mean pain numeric 
      rating scale (NRS) scores for the 24-hour period beginning at 7:00 on 
      post-operative day 1. RESULTS: A total of 22 patients were included in this study 
      (11-cPVB and 11-tPVB). The mean NRS pain score of cPVB patients (3.5 (standard 
      deviation (SD) 1.8) was lower than that of the single-injection tPVB patients 
      (4.4 (SD 2.1), however this difference was not statistically significant (P = 
      0.31). The length of hospital stay and opioid use was not statistically different 
      between groups. CONCLUSIONS: Patients receiving a cPVB in addition to tPVB after 
      LDF reconstruction experienced similar pain to those receiving tPVB alone. A 
      larger, randomized clinical trial is warranted to fully determine the benefits of 
      using cPVB in addition to tPVB for this procedure.
FAU - Unkart, Jonathan T
AU  - Unkart JT
AD  - Department of Surgery, University of California, San Diego, USA.
FAU - Padwal, Jennifer A
AU  - Padwal JA
AD  - School of Medicine, University of California, San Diego, USA.
FAU - Ilfeld, Brian M
AU  - Ilfeld BM
AD  - Department of Anesthesiology, University of California, California, USA.
FAU - Wallace, Anne M
AU  - Wallace AM
AD  - Department of Surgery, University of California, San Diego, USA.
LA  - eng
PT  - Journal Article
DEP - 20160724
PL  - Netherlands
TA  - Anesth Pain Med
JT  - Anesthesiology and pain medicine
JID - 101585412
PMC - PMC5101420
OTO - NOTNLM
OT  - Breast Reconstruction
OT  - Continuous Paravertebral Catheter
OT  - Latissimus Dorsi Flap
EDAT- 2016/11/17 06:00
MHDA- 2016/11/17 06:01
PMCR- 2016/07/24
CRDT- 2016/11/17 06:00
PHST- 2016/05/12 00:00 [received]
PHST- 2016/06/24 00:00 [revised]
PHST- 2016/06/26 00:00 [accepted]
PHST- 2016/11/17 06:00 [entrez]
PHST- 2016/11/17 06:00 [pubmed]
PHST- 2016/11/17 06:01 [medline]
PHST- 2016/07/24 00:00 [pmc-release]
AID - 10.5812/aapm.39476 [doi]
PST - epublish
SO  - Anesth Pain Med. 2016 Jul 24;6(5):e39476. doi: 10.5812/aapm.39476. eCollection 
      2016 Oct.