Enhanced Recovery Cuts Opioid Use and Stay After Mastectomy

Enhanced recovery after surgery (ERAS) pathways have been widely shown to improve outcomes, including in plastic surgery. Researchers has previously validated ERAS in patients with breast cancer undergoing deep inferior epigastric perforator flap reconstruction.

Nicholas T. Haddock and the team aimed to evaluate whether the ERAS protocol and addition of liposomal bupivacaine affected outcomes in patients undergoing mastectomy and first-stage tissue expander reconstruction.

The study retrospectively reviewed patients treated from July 2021 to May 2022. The ERAS protocol, including liposomal bupivacaine in the pectoralis nerve block 1/2 planes, was implemented in December 2021. They compared 2 groups including pre-ERAS and ERAS. Primary outcomes were postoperative length of stay and hospital narcotic use.
The results showed that 81 patients were analyzed, with 41 in the pre-ERAS group and 83 in the ERAS group. Postoperative length of stay was significantly reduced in the ERAS group (1.7 pre-ERAS vs 1.1 ERAS, P= .0004). Morphine equivalents in the recovery room were similar between groups, with average PACU pain morphine equivalents of 6.1 pre-ERAS vs 7.1 ERAS (P= .406). However, total hospital morphine equivalents were significantly lower in the ERAS group (65.0 pre-ERAS vs 26.2 ERAS, P= <.001).

The study concluded that implementing an enhanced recovery after surgery protocol with liposomal bupivacaine pectoralis 1/2 nerve blocks reduced postoperative opioid consumption and hospital length of stay in patients undergoing mastectomy and first-stage tissue expander reconstruction.

No funding information was available.

Source: https://pubmed.ncbi.nlm.nih.gov/39147381/

Haddock NT, Cummins S, Lakatta AC, et al. (2024). “Enhanced Recovery After Surgery (ERAS) With Exparel in Tissue Expander-based Breast Reconstruction Following Mastectomy.” Aesthet Surg J. 2024;44(Supplement_1):S15-S21. doi:10.1093/asj/sjae003