Comparison of Tumescent Anesthesia and PECS II Block in Bilateral Reduction Mammaplasty
Caroline M McLaughlin1, Alexa J Hughes2, Charles Lee2, Dennis J Warfield3, John D Potochny1
1Penn State Health Milton S. Hershey Medical Center, Division of Plastic Surgery, Hershey, PA; 2Penn State College of Medicine, Hershey, PA; 3Penn State Health Milton S. Hershey Medical Center, Department of Anesthesia, Hershey, PA
Introduction: With an increasing focus on perioperative multimodal pain control to reduce narcotic requirements, regional and local anesthesia techniques have been investigated in the context of bilateral reduction mammaplasty with variable results. The purpose of this study is to compare tumescent anesthesia with ultrasound-guided pectoral nerve block type II (PECS II Block) in patients undergoing bilateral reduction mammaplasty with respect to postoperative pain and nausea, narcotic consumption, length of stay, and cost.
Methods: A retrospective review of patients undergoing bilateral reduction mammaplasty for macromastia between November 2020 and December 2021 was performed. Demographic information, operative and anesthesia times, antiemetic and morphine equivalent requirements, postoperative numeric pain rating scales, and time until hospital discharge was compared between groups. Chi-squared and Fisher’s exact tests were used to examine subgroup differences in categorical variables. Two sample T-test and Wilcoxon rank-sum test were used to evaluate differences in continuous parametric and non-parametric variables, respectively.
Results: 53 patients underwent bilateral reduction mammaplasty by three surgeons, 71.7% (n=38) with tumescent anesthesia infiltrated by the operating surgeon prior to the start of the procedure and 28.3% (N=15) with bilateral PECS II blocks performed by anesthesia prior to the start of the procedure. There was no difference in age, BMI, weight resected, intraoperative medication quantities, or immediate postoperative complications. Non-procedure anesthesia time, postoperative pain scores, and narcotic requirements were similar between the two groups. 21.1% (N=8) of tumescent patients compared to 66.7% (N=10) of block patients required one or more doses of postoperative antiemetics (p-value = 0.002). A total of five patients, one undergoing blocks and four tumescent, required overnight hospitalization. Patients who received blocks spent longer in the postoperative recovery area (5.3 hours, standard deviation [SD] = 5.0 vs 7.1 hours, SD=4.1, p=0.005). However, this did not translate to a significant increase in overnight stays. The block group had higher overall cost by an average of $4,000, driven by pharmacy and procedural cost.
Conclusion: In this cohort of multimodal perioperative pain-controlled reduction mammaplasty patients, tumescent anesthesia was associated with decreased antiemetic requirements, less time in recovery prior to discharge, and lower cost compared to PECS II blocks. Therefore, tumescent anesthesia may be favored over PECS II blocks when considering multimodal pain control strategies in reduction mammaplasty patients.
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