Abstract P2-13-11: Multimodality perioperative analgesia with paravertebral nerve block and gabapentin reduces narcotic use and hospital length of stay in mastectomy patients

Abstract

Abstract Postoperative pain control is the major determinant in hospital length of stay (LOS) in patients undergoing mastectomy. Using a multimodality approach for peri-operative analgesia (PA) with paravertebral nerve block (PVB)(regional anesthesia) as well as including pre- and postoperative oral gabapentin, we significantly reduced both LOS and narcotic usage (NU) when compared to PVB alone or conventional postoperative management (CPM) with on demand postoperative pain medications. A single institution, retrospective chart review of patients undergoing mastectomy from 2009 to 2014 was performed (n = 129; 84 bilateral, 45 unilateral) with a subset analysis performed on patients undergoing tissue expander (TE) reconstruction (n=86) or bilateral mastectomies (n=84). Patients were grouped by PA type (CPM, PVB by catheter infusion, and PVB with gabapentin (PVB+G)). Data were analyzed via using Student t-test and significance was defined as p<0.05. As seen in the table below, LOS and NU decreased with increasing multimodal PA approach. LOS was significantly decreased by PVB+G compared to CPM and PVB for all mastectomies, bilateral mastectomies, and mastectomies with tissue expander (TE) reconstruction. NU was significantly decreased by PVB+G compared to CPM and PVB for all mastectomies and bilateral mastectomies, and trended toward decreasing NU in TE reconstruction. All (n = 129)(1) CPM (n=51)(2) PVB (n=35)(3) PVB+G (n=53)p 1 vs 3; p 2 vs 3LOS (days)2.3 (0.84)2.1 (0.71)1.61 (0.54)<0.0001; <0.0005NU (mg)73 (42.9)52 (32.3)39 (25.3)<0.001; 0.04TE reconstruction (n=86)(1) CPM (n=25)(2) PVB (n=21)(3) PVB+G (n=40) LOS (days)2.2 (0.50)2.3 (0.63)1.61 (0.44)<0.001;<0.001NU (mg)86 (32.6)55 (34.4)43 (36.3)<0.001; 0.10Bilateral (n=84)(1) CPM (n=20)(2) PVB (n=24)(3) PVB+G (n=40) LOS (days)2.4 (0.7)2.2 (0.72)1.65 (0.52)<0.009;<0.001NU (mg)84 (37.4)58 (32.4)38 (24.5)<0.001;0.0066NU = narcotic use normalized to morphine sulfate We have found employing a multimodality approach to PA with the addition of the GABA analogue, gabapentin, to regional anesthesia via PVB catheter infusion significantly improves the postoperative course of patients undergoing mastectomy procedures by decreasing LOS and NU. Citation Format: Zandra H Cheng, Vlad Frenk, Jennifer D Bishop, Theresa Bowling, Helen A Pass. Multimodality perioperative analgesia with paravertebral nerve block and gabapentin reduces narcotic use and hospital length of stay in mastectomy patients [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-13-11.