Bupivacaine Versus Liposomal Bupivacaine For Breast Pain Management After Breast Recontruction

Prospective, Randomized, Blinded Comparison of Bupivacaine Versus Liposomal Bupivacaine For Breast Pain Management After Unilateral, Immediate Breast Reconstruction

The purpose of this study is to determine the most effective way to control post-operative breast pain for patients undergoing a unilateral, immediate breast reconstruction.

This is a randomized controlled study to compare the effectiveness of a breast nerve block performed with bupivacaine as compared to liposomal bupivacaine in providing postsurgical analgesia in patients undergoing unilateral abdominally-based breast reconstruction at time of mastectomy. OBJECTIVES Compare the amount of postoperative narcotic use in patients receiving a bupivacaine or liposomal bupivacaine pectoralis and serratus anterior nerve block. Compare these groups to a retrospective control cohort who received local anesthetic infusion but did not receive any nerve block. Examine the incidence of narcotic-related side effects in the experimental groups by documenting incidents of nausea and vomiting, time to first ambulation, liquid and solid oral intake. Survey patient satisfaction with pain management using a visual analog scale during their hospital stay.

This group will receive a long-acting pain medicine, Liposomal Bupivacaine, injected into the breast muscles during surgery. All patients will receive patient-controlled analgesia pump and oral narcotics as indicated post surgery.

This group will receive the same pain medication, Bupivacaine, but in the standard formulation, injected into the breast muscles during surgery. All patients will receive patient-controlled analgesia pump and oral narcotics as indicated post surgery.

20mL vial of Liposomal Bupivacaine (266 mg). The infiltration technique for Liposomal Bupivacaine will be 80mL injected into either hemi-abdomen as a transversus abdominous plane (TAP) block via ultrasound guidance. The other 80mL will be utilized in the operative breast for the field blocks (20mL), pectoralis 1 (20mL), pectoralis 2 (20mL) and serratus anterior (20mL) blocks.

Sensorcaine-Methyl Paraben Free (MPF) Spinal, Sensorcaine-MPF, Sensorcaine, ReadySharp Bupivacaine, P-Care M, Marcaine Spinal, Marcaine Preservative Free, Marcaine, Bupivacaine Spinal

20mL vial of 0.25% Bupivacaine. The field blocks (20mL), pectoralis 1 (20mL), pectoralis 2 (20mL) and serratus anterior (20mL) blocks will be performed with 0.25% Bupivacaine.

The patient-controlled anesthesia will be filled with morphine or hydromorphone. Pumps will be programmed be on demand only with no basal rate.

Oral narcotics will be offered when the patient's diet is advanced as tolerated, typically post-operative day 1.

post-operative pain as measured by total post-operative narcotic utilization standardized to milligrams of morphine.

Inclusion Criteria: Patients scheduled to have a unilateral, immediate breast reconstruction Exclusion Criteria: Pregnant Concurrent or recent medical condition that could interfere with study participation including: Hepatitis Alcohol/substance abuse Uncontrolled psychiatric disorders Known allergy Contraindication to amide-type local anesthetics, opioids, or propofol. Body weight of less than 50 kg Participated in another study involving an investigational medication within the prior 30 days Taking analgesics (i.e., nonsteroidal anti-inflammatory drugs, acetaminophen, or opioids), antidepressants, or glucocorticoids within the 3 days before surgery.