The management of
postoperative pain is of critical importance for women undergoing
breast reconstruction after surgical treatment for
breast cancer. Mitigating
postoperative pain can improve health-related quality of life, reduce health care resource utilization and costs, and minimize perioperative
opiate use. Multimodal
analgesia pain management strategies with
nonopioid analgesics have improved the value of surgical care in patients undergoing various operations but have only recently been reported in reconstructive breast surgery.
Regional anesthesia techniques, with paravertebral blocks (PVBs) and transversus abdominis plane (TAP) blocks, and
enhanced recovery after surgery (ERAS) pathways have been increasingly utilized in
opioid-sparing multimodal
analgesia protocols for women undergoing
breast reconstruction. The objectives of this review are to 1) comprehensively review
regional anesthesia techniques in
breast reconstruction, 2) outline important components of ERAS protocols in
breast reconstruction, and 3) provide evidence-based recommendations regarding each intervention included in these protocols. The authors searched across six databases to identify relevant articles. For each perioperative intervention included in the ERAS protocols, the literature was exhaustively reviewed and evidence-based recommendations were generated using the Grading of Recommendations, Assessment, Development, and Evaluation system methodology. This study provides a comprehensive evidence-based review of interventions to optimize
perioperative care and
postoperative pain control in
breast reconstruction. Incorporating evidence-based interventions into future ERAS protocols is essential to ensure high value care in
breast reconstruction.