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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer 2021
Materias:	Surgery RD1-811
Acceso en línea:	https://doaj.org/article/74d7ca4ae4a04296aa21eef9db13a32c
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spelling	oai:doaj.org-article:74d7ca4ae4a04296aa21eef9db13a32c2021-11-25T07:58:04ZOpioid-sparing Strategies in Alloplastic Breast Reconstruction: A Systematic Review2169-757410.1097/GOX.0000000000003932https://doaj.org/article/74d7ca4ae4a04296aa21eef9db13a32c2021-11-01T00:00:00Zhttp://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003932https://doaj.org/toc/2169-7574Introduction:. 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.Dustin T. Crystal, MDAhmed M. S. Ibrahim, MD, PhDLouise L. Blankensteijn, MDNicholas G. Cuccolo, MDDarya Kazei, MDHelen S. Zitkovsky, BABernard T. Lee, MD, MPH, MBASamuel J. Lin, MD, MBAWolters KluwerarticleSurgeryRD1-811ENPlastic and Reconstructive Surgery, Global Open, Vol 9, Iss 11, p e3932 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Surgery RD1-811
spellingShingle	Surgery RD1-811 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
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.
format	article
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
title	Opioid-sparing Strategies in Alloplastic Breast Reconstruction: A Systematic Review
title_short	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_sort	opioid-sparing strategies in alloplastic breast reconstruction: a systematic review
publisher	Wolters Kluwer
publishDate	2021
url	https://doaj.org/article/74d7ca4ae4a04296aa21eef9db13a32c
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Opioid-sparing Strategies in Alloplastic Breast Reconstruction: A Systematic Review

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