Multiple intramuscular ropivacaine injections to donor sites reduces pain in deep inferior epigastric artery perforator flap breast reconstruction

Juyoung Bae, Dong Ryeol Shin, Jee Yeon Sohn, Jin Woo Park, Kyongje Woo

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Local anesthetic infiltration at the surgical site has been studied in various surgical disciplines; however, its impact on deep inferior epigastric artery perforator (DIEP) flap breast reconstruction has not been previously assessed. This study aimed to evaluate the effects of multiple intramuscular ropivacaine injections on donor site pain during DIEP flap breast reconstruction. Methods: The study included 65 patients who received local ropivacaine injections during DIEP reconstructions between March 2022 and February 2023, compared to 55 patients who underwent surgeries without ropivacaine from October 2018 to July 2020. A total of 20 cc of 0.75% ropivacaine solution was evenly administered at 20 sites along the abdominal wall muscles. The effect of intramuscular ropivacaine injection on postoperative visual analog scale (VAS) was evaluated using linear mixed-effect model. Opioid consumption and hospital days were also compared. Results: The daily median VAS score was lower in the ropivacaine group (all p-values < 0.001). When analyzed using a linear mixed-effects model, those who received ropivacaine had significantly lower VAS scores over the first 5 days postoperatively (p-value < 0.001). The rate of VAS score decline was also faster in the ropivacaine group over the first 24 h postoperative (p-value = 0.045). Although opioid consumption was comparable between the groups, those receiving ropivacaine had significantly shorter hospital stay (p-value = 0.001) and no complications related to the injections were observed. Conclusion: Multiple intramuscular injections of ropivacaine to the donor site may reduce postoperative pain and shorten hospital stays, without increasing opioid consumption.

Original languageEnglish
Pages (from-to)82-90
Number of pages9
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Volume98
DOIs
StatePublished - Nov 2024

Bibliographical note

Publisher Copyright:
© 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons

Keywords

  • Breast reconstruction
  • Deep inferior epigastric artery perforator free flap
  • Local anesthetic infiltration
  • Multimodal pain management
  • Ropivacaine

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