Regional Pain Blocks and Perioperative Pain Control in Patients Undergoing Breast Implant Removal with Capsulectomy

Abstract

ABSTRACT Background Demand for breast implant removal with capsulectomy is on the rise, with more than 36,000 explants performed in 2020, an increase of nearly 7.5% from previous years. Postoperative analgesia is an important consideration in this patient group due to scar tissue surrounding the implant and the potential for extensive dissection during capsulectomy. Objectives We sought to compare perioperative pain control between several different types of ultrasound-guided regional anesthetic techniques in patients undergoing implant removal with capsulectomy. Methods We reviewed all patients who received an ultrasound-guided block and underwent breast implant removal with capsulectomy at our outpatient surgical center over a two-year period. We compared intraoperative, postoperative opioid requirement, and patient-reported pain on the first postoperative day (POD1) between three different block techniques using chi-square analysis. A p-value <0.05 was considered statistically significant. Results 352 patients met inclusion criteria. 26 patients (7.4%) underwent a serratus plane block (SP), 13 (3.7%) underwent an erector spinae combined with pectointercostal fascial plane block (ES+PIFP), and 313 (88.9%) underwent an erector spinae combined with pectoral nerve block (ES+PECS1). ES+PECS1 was associated with less intraoperative and postoperative opioid use compared with SP and ES+PIFP (1.9% vs 19.2% vs 61.5%, p<0.001 for intraoperative, 26.8% vs 34.6% vs 38.5% postoperative, p<0.001). ES+PECS1 block was associated with mild pain on POD1 compared with the other two regional block techniques (p=0.001). Conclusions Regional pain blocks, and specifically the ES block offer effective pain control for patients undergoing breast implant removal with capsulectomy, demonstrating high patient satisfaction in the postoperative period with low opioid requirements.