The efficacy of continuous local anesthetic infiltration in breast surgery: Reduction mammaplasty and reconstruction

Background: Pain control after reduction mammaplasty and breast reconstruction with tissue expanders often requires intravenous narcotic analgesia and inpatient hospitalization. Regional and local anesthetic techniques are increasing in popularity because they decrease the use of intravenous analgesic medications and offer comparable pain relief without the systemic side effects. Methods: This study examined the use of in-dwelling catheters for the continuous infiltration of local anesthetic (bupivacaine) in 74 consecutive breast reduction and 74 consecutive tissue expander breast reconstruction patients. Patients entering the study before February of 2003 had conventional methods of analgesia (39 patients for each group), whereas those entering afterwards received the infusion pumps (35 patients for each group). Results: The number of hospital admissions among the breast reduction patients with infusion pumps was significantly less than that for those without pumps (p < 0.01). Pain, measured on averbal response scale of 0 to 10, while in the recovery room was significantly less in the pain pump group than in the comparison group (p < 0.01), as were cumulative amounts of pain medications (p < 0.01). There were no statistically significant differences in the number of complications or in the rate of nausea or vomiting. The number of inpatient days among the tissue expander reconstruction patients with infusion pumps was not significantly different from that for those without pumps; the average pain score was significantly lower (p < 0.01). The cumulative amounts of pain medication in patients receiving the infusion pump were significantly lower than those in patients without the pumps (p < 0.01). There were no statistically significant differences in the number of complications or in the rate of nausea or vomiting. There were no tissue expander infections in patients with the indwelling catheters adjacent to the implant. Conclusions: The continuous infiltration of local anesthetic with an infusion pump represents another tool for pain management in surgical patients.