Effect of erector spinae plane block and thoracic epidural anesthesia on hospital length of stay and postoperative opioid use after mastectomy.

BACKGROUND

Adequate postoperative pain control is essential after mastectomy. This study compares the influence of 2 regional analgesia techniques on length of stay and opioid use to systemic analgesia alone.

METHODS

Patients treated with mastectomy from 2014 to 2020 were stratified according to perioperative analgesic modality (systemic analgesia versus thoracic epidural anesthesia or erector spinae plane block). Demographic, tumor, and treatment characteristics were compared. Outcome variables included postoperative anesthesia unit and hospital length of stay, postoperative day 1 and 2 discharge rates, and inpatient opioid use (in oral milligram morphine equivalents).

RESULTS

Of 316 patients, 171 received systemic analgesia, 72 thoracic epidural anesthesia, and 73 erector spinae plane block. On univariate analysis, there were significant differences in age, neoadjuvant chemotherapy, bilateral surgery, immediate reconstruction, and Her2 positivity rates. Thoracic epidural anesthesia had the longest hospital length of stay, and erector spinae plane block the shortest, compared with systemic analgesia (52.1 vs 28 vs 30.6 hours, P < .0001). Postoperative day 1 discharge was more likely with erector spinae plane block than systemic analgesia and less likely with thoracic epidural anesthesia (89% vs 68.4% vs 30.6%, P < .0001). Erector spinae plane block required significantly less milligram morphine equivalents than thoracic epidural anesthesia or systemic analgesia on postoperative day 1 (10 vs 18.75 vs 20 milligram morphine equivalents, P < .0009), but no differences on postoperative day 2 (23.5 vs 20 vs 25 milligram morphine equivalents, P = .84). Total hospital opioid use was significantly lower for erector spinae plane block than thoracic epidural anesthesia or systemic analgesia (24 vs 32.3 vs 32 milligram morphine equivalents, P = .024). On multivariate analysis, thoracic epidural anesthesia was associated with significantly longer length of stay, whereas neither thoracic epidural anesthesia nor erector spinae plane block was associated with decreased opioid use.

CONCLUSION

Regional analgesia is not significantly associated with decreased opioid use or hospital length of stay.