Regional anesthesia without opioid administration in mastectomy surgeries followed by breast reconstruction with implants: a randomized controlled study.

Aim: To compare regional anesthesia without opioid administration following subcutaneous mastectomy and breast reconstruction with implants in the pre-pectoral plane with general anesthesia in terms of pain relief, opioid consumption, and hospital stay duration.

Methods: This randomized controlled study enrolled patients who underwent mastectomy with reconstruction of the breast either with permanent implants or tissue expander placement in the pre-pectoral plane. A total of 40 patients met the inclusion criteria. The regional anesthesia group (n=20) received a pectoralis muscle block (PECS I), thoracic paravertebral block (TPVB), and serratus anterior muscle plane block (SAP) following a uniform protocol, and the control group (n=20) underwent general anesthesia. Pain was assessed by using the numeric rating scale (NRS) from 30 minutes after surgery up to ten days postoperatively.

Results: NRS pain scores were significantly higher in the regional anesthesia group, independent of the patients' physical daily activity level, even up to 10 days after surgery. Opioid consumption and length of hospital stay did not differ significantly.

Conclusion: Regional anesthesia using a combination of a TBVP, PECS I, and SAP has a long-lasting and satisfactory analgesic effect without the introduction of opioids. In the future, a novel gold standard protocol should be established that can be offered to every patient undergoing breast surgery.