Paravertebral blocks and enhanced recovery after surgery protocols in breast reconstructive surgery: patient selection and perspectives

Figures & data

Table 1 Characteristics of studies comparing breast reconstruction outcomes for patients in an ERAS protocol to conventional care

Authors	Location	Year	Methods	Participants in ERAS protocol, n	Participants in usual care protocol, n	Perioperative interventions included in ERAS protocol	Outcomes
Batdorfet al^Citation64	USA	2015	Retrospective cohort	49	51	Preoperative education; fasting only 2 hours for clear liquids prior to surgery; antimicrobial prophylaxis; multimodal analgesia with opiates, NSAIDs, acetaminophen, gabapentin + TAP blocks with liposomal bupivacaine; euvolemia fluid management; antiemetics; oral feeding on POD 0; early ambulation; urinary catheter removal POD 1	Length of stay, total opiate use, pain scores, flap loss, systemic complications, surgical complications
Bonde et al^Citation65	Denmark	2015	Case–control	177	277	Preoperative education; antimicrobial prophylaxis; multimodal analgesia with opiates (on request), NSAIDs and acetaminophen; early ambulation; urinary catheter removal POD 1	Length of stay, surgical complications, flap loss
Bonde et al^Citation66	Denmark	2016	Retrospective cohort	16	N/A	Preoperative education; antimicrobial prophylaxis; multimodal analgesia with opiates (on request), NSAIDs, acetaminophen, and gabapentin; minimally invasive approach (DIEP flaps only); oral feeding on POD 1; early ambulation; urinary catheter removal POD 1	Length of stay, surgical complications, flap loss
Afonso et al^Citation63	USA	2017	Retrospective cohort	42	49	Preoperative education; fasting only 2 hours for clear liquids prior to surgery; multimodal analgesia with opiates, NSAIDs (IV ketorolac), and acetaminophen + TAP blocks with liposomal bupivacaine; goal-directed fluid management; antiemetics; oral feeding on POD 1; early ambulation; urinary catheter removal POD 1	Length of stay, total opiate use, pain scores, flap loss, systemic complications, surgical complications
Dumestre et al^Citation67	Canada	2017	Retrospective cohort	29	29	Preoperative education; fasting only 3 hours for clear liquids prior to surgery; multimodal analgesia with opiates, celecoxib/NSAIDs, and acetaminophen + local nerve blocks with bupivacaine	Length of stay, QoR scores, pain scores, systemic complications, surgical complications

Abbreviations: DIEP, deep inferior epigastric artery perforator; ERAS, enhanced recovery after surgery; NSAIDs, nonsteroidal anti-inflammatory drugs; POD, postoperative day; QoR, quality of recovery; TAP, transversus abdominis plane; N/A, not available.

BatdorfNJLemaineVLovelyJKEnhanced recovery after surgery in microvascular breast reconstructionJ Plast Reconstr Aesthet Surg201568339540225488326

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BondeCKhorasaniHEriksenKWolthersMKehletHElbergJIntroducing the fast track surgery principles can reduce length of stay after autologous breast reconstruction using free flaps: a case control studyJ Plast Surg Hand Surg201549636737126161838

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BondeCTKhorasaniHElbergJKehletHPerioperative optimization of autologous breast reconstructionPlast Reconstr Surg2016137241141426818274

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AfonsoAOskarSTanKSIs enhanced recovery the new standard of care in microsurgical breast reconstruction?Plast Reconstr Surg201713951053106128092334

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DumestreDOWebbCETemple-OberleCImproved recovery experience achieved for women undergoing implant-based breast reconstruction using an enhanced recovery after surgery modelPlast Reconstr Surg2017139355055928234819

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