The effect of a local anesthetic cocktail in a serratus anterior plane and PECS 1 block for implant-based breast reconstruction

IntroductionEnhanced Recovery After Surgery (ERAS) protocols have been implemented to decrease opioid use and decrease patient length of stay (LOS, days). Serratus Anterior Plane (SAP) blocks anesthetize the T2 through T9 dermatomes of the breast and can be applied intra-operatively. The purpose of this study is to compare postoperative opioid (OME) consumption and length-of-stay (LOS) between a control group, an ERAS group, and an ERAS/local anesthetic cocktail group in patients undergoing implant-based breast reconstruction.Methods142 women undergoing implant-based breast reconstruction between 2004 and 2020 were divided into Group A (46 pts), a historical cohort, Group B (73 pts), an ERAS/no-block control group, and Group C (23 pts), an ERAS/anesthetic cocktail study group. Primary outcomes of interest were PACU (Post-Anesthesia Care Unit), Inpatient, and Total Hospital OME consumption and PACU LOS.ResultsThere was a significant decrease from Group A to C in PACU LOS (103.3 vs 80.2 vs 70.5; p=0.011) and OME use (25.1 vs 11.4 vs 5.7; p<0.0001) and Total Hospital OME (120.3 vs 95.2 vs 35.9; p<0.05). No difference was seen in inpatient OMEs between the three groups (95.2 vs 83.8 vs 30.8; p=0.212). Despite not reaching statistical significance, Group C consumed an average of 50-60% less opioids per patient than Group B in PACU, Inpatient, and Total Hospital OMEs.ConclusionLocal anesthetic blocks are an important component of ERAS protocols. Our results demonstrate that a combination regional block with a local anesthetic cocktail into an ERAS protocol can decrease opioid consumption in implant-based breast reconstruction.