Date Published: August 8, 2017
Publisher: Springer US
Author(s): Chang Min Kang, Woo Jeong Kim, Sean Hyuck Yoon, Chul Bum Cho, Jeong Su Shim.
In breast augmentation with implant, there is severe pain due to damage from expansion of breast tissue and the pectoralis major. Therefore, the authors conducted this study to analyze the effectiveness of postoperative intercostal nerve block (ICNB) in reducing postoperative pain after breast augmentation with implant.
Forty-four female patients were enrolled in the study. Just before awaking from general anesthesia, 34 cases were injected with 0.2% ropivacaine to both third, fourth, fifth, and sixth intercostal spaces. We compared them (ICNB group) with the control group for VAS scores at the time of arrival in the recovery room, after 30, 60, and 120 min.
The average VAS scores per time of the control group and ICNB group were 7.1 ± 0.74 and 3.50 ± 1.81 at arrival time in the recovery room, 7.00 ± 0.67 and 3.03 ± 1.47 after 30 min, 5.50 ± 0.71 and 2.68 ± 1.49 after 60 min, and 4.60 ± 0.84 and 2.00 ± 1.35 after 120 min. VAS scores of two groups were significantly different at each time and decreased overall. Also, time and group effect of the two groups were significantly different, especially between 30 and 60 min.
ICNB just before awaking from general anesthesia showed a statistically significant reduction in VAS score, and this means postoperative pain was reduced effectively and time to discharge could be shortened. Therefore, it can be a good way to reduce postoperative pain after augmentation mammoplasty with implant.
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The online version of this article (doi:10.1007/s00266-017-0802-6) contains supplementary material, which is available to authorized users.
Augmentation mammoplasty using a breast prosthesis requires the insertion of an implant under breast tissue. Implant insertion levels are classified as subglandular, subpectorial or dual-plane based on the pectoralis major. Generally, subglandular insertion can be applied in patients with abundant breast tissue and mild glandular hypomastia, and in such cases soft breast tissue should be enough to cover the implant . However, in Korean women, subpectoral or dual-plane insertion is mainly performed to reduce sagging after surgery and to avoid problems of implant palpability and visuality due to poor breast tissue after subglandular insertion.
Patients and Preoperative Evaluations
The control (n = 10) and intercostal nerve block patients (ICNB group, n = 34) had average ages of 30.90 ± 7.37 and 31.50 ± 6.97, average heights of 162.20 ± 2.35 and 162.62 ± 3.95 cm, average weights of 50.20 ± 2.74 and 51.12 ± 4.82 kg, and average BMIs of 19.05 ± 0.66 and 19.04 ± 1.24 kg/m2, respectively (Table 1). Of the 44 study subjects, 43 were normal healthy patients without active disease (ASA score 1), and the other patient had an ASA score of 2 due to PVC bigeminy.Table 1Patient demographics and baseline characteristicsICNBControlp valueaAge31.50 ± 6.9730.90 ± 7.370.814Height (cm)162.62 ± 3.95162.20 ± 2.350.753Weight (kg)51.12 ± 4.8250.20 ± 2.740.570BMI (kg/m2)19.04 ± 1.2419.05 ± 0.660.971Results are presented as means ± SDsBMI body mass index, ASA American society of anesthesiologistsaResult by two-sample t test
According to the statistics compiled by The International Society of Aesthetic Plastic Surgery (ISAPS) in 2015, augmentation mammoplasty is the third most common form of cosmetic surgery conducted worldwide. In Korea, augmentation mammoplasty is the fourth most common form of cosmetic surgery; over 20,000 surgeries are performed annually and numbers continue to increase . Accordingly, there is an increasing demand to reduce postoperative pain and increase speed of recovery.
In the present study, intercostal nerve block, when conducted just before recovery from general anesthesia, significantly reduced pain in patients undergoing augmentation mammoplasty, as determined by VAS scores. This finding means postoperative pain reduction was effectively achieved, and as a result, rapid recovery and discharge were achieved. Therefore, the study indicates intercostal nerve block conducted just before recovery from general anesthesia should be considered an effective means of pain reduction and worthy of additional study.