Addition of Erector Spinae Nerve Block Effect on Opioid Use and Pain Levels in Reduction Mammoplasty.

Abstract

Background: Macromastia causes significant physical and emotional distress. Reduction mammoplasty often requires opioid analgesia. This study compared the efficacy of combining an erector spinae plane (ESP) block with a field block of long-acting bupivacaine (LLAB) versus LLAB alone in managing pain and opioid use during breast reduction surgery.

Methods: We conducted a retrospective review of breast reduction patients from March 2021 to March 2022 at an academic center. The variables included specimen weights, liposuction volume, opioid use (standardized to morphine milligram equivalents [MME]), and pain scores (0-10 scale). Two-sample z tests were used to assess significance.

Results: Ninety-eight patients were analyzed: 50 received ESP blocks with LLAB, and 48 received LLAB alone. The ESP block group had significantly lower perioperative opioid use (33.5 versus 89.8 MME, P < 0.001). Preoperative opioid use was similar (27.8 versus 31.5 MME, P = 0.16). Postoperative opioid use trended lower in the ESP block group (22.5 versus 31.4 MME, P = 0.06). ESP block patients also reported lower postanesthesia care unit pain scores (4.3 versus 6.0, P < 0.001) and fewer postdischarge pain medication refills (12.0% versus 20.8%, P = 0.02).

Conclusions: ESP blocks with LLAB reduced perioperative opioid use, immediate postoperative pain, and the need for postdischarge refills compared with LLAB alone. Although postoperative opioid reduction was not statistically significant, a clear trend was observed. These findings support further evaluation and potential adoption of the ESP block in breast reduction procedures.