Anesthesiology and Pain Medicine

Published by: Kowsar

Treatment of Post-Latissimus Dorsi Flap Breast Reconstruction Pain With Continuous Paravertebral Nerve Blocks: A Retrospective Review

Jonathan T. Unkart 1 , * , Jennifer A. Padwal 2 , Brian M. Ilfeld 3 and Anne M. Wallace 1
Authors Information
1 Department of Surgery, University of California, San Diego, USA
2 School of Medicine, University of California, San Diego, USA
3 Department of Anesthesiology, University of California, California, USA
Article information
  • Anesthesiology and Pain Medicine: October 01, 2016, 6 (5); e39476
  • Published Online: July 24, 2016
  • Article Type: Research Article
  • Received: May 12, 2016
  • Revised: June 24, 2016
  • Accepted: June 26, 2016
  • DOI: 10.5812/aapm.39476

To Cite: Unkart J T, Padwal J A, Ilfeld B M, Wallace A M. Treatment of Post-Latissimus Dorsi Flap Breast Reconstruction Pain With Continuous Paravertebral Nerve Blocks: A Retrospective Review, Anesth Pain Med. 2016 ; 6(5):e39476. doi: 10.5812/aapm.39476.

Copyright © 2016, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Background
2. Objectives
3. Methods
4. Results
5. Discussion
  • 1. Youlden DR, Cramb SM, Dunn NA, Muller JM, Pyke CM, Baade PD. The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality. Cancer Epidemiol. 2012; 36(3): 237-48[DOI][PubMed]
  • 2. Habermann EB, Abbott A, Parsons HM, Virnig BA, Al-Refaie WB, Tuttle TM. Are mastectomy rates really increasing in the United States? J Clin Oncol. 2010; 28(21): 3437-41[DOI][PubMed]
  • 3. Mejdahl MK, Andersen KG, Gartner R, Kroman N, Kehlet H. Persistent pain and sensory disturbances after treatment for breast cancer: six year nationwide follow-up study. BMJ. 2013; 346[DOI][PubMed]
  • 4. Jung BF, Ahrendt GM, Oaklander AL, Dworkin RH. Neuropathic pain following breast cancer surgery: proposed classification and research update. Pain. 2003; 104(1-2): 1-13[PubMed]
  • 5. Tasmuth T, von Smitten K, Hietanen P, Kataja M, Kalso E. Pain and other symptoms after different treatment modalities of breast cancer. Ann Oncol. 1995; 6(5): 453-9[PubMed]
  • 6. Imani F. Postoperative pain management. Anesth Pain Med. 2011; 1(1): 6-7[DOI][PubMed]
  • 7. Imani F, Rahimzadeh P. Interventional pain management according to evidence-based medicine. Anesth Pain Med. 2012; 1(4): 235-6[DOI][PubMed]
  • 8. Imani F, Safari S. "Pain Relief is an Essential Human Right", We Should be Concerned about It. Anesth Pain Med. 2011; 1(2): 55-7[DOI][PubMed]
  • 9. Eltahir Y, Werners LL, Dreise MM, van Emmichoven IA, Jansen L, Werker PM, et al. Quality-of-life outcomes between mastectomy alone and breast reconstruction: comparison of patient-reported BREAST-Q and other health-related quality-of-life measures. Plast Reconstr Surg. 2013; 132(2): 201-9[DOI][PubMed]
  • 10. 2013 Plastic Surgery Statistics Report. 2016;
  • 11. Albornoz CR, Bach PB, Mehrara BJ, Disa JJ, Pusic AL, McCarthy CM, et al. A paradigm shift in U.S. Breast reconstruction: increasing implant rates. Plast Reconstr Surg. 2013; 131(1): 15-23[DOI][PubMed]
  • 12. Hirsch EM, Seth AK, Kim JY, Dumanian GA, Mustoe TA, Galiano RD, et al. Analysis of risk factors for complications in expander/implant breast reconstruction by stage of reconstruction. Plast Reconstr Surg. 2014; 134(5): 692-9[DOI][PubMed]
  • 13. Lam TC, Hsieh F, Boyages J. The effects of postmastectomy adjuvant radiotherapy on immediate two-stage prosthetic breast reconstruction: a systematic review. Plast Reconstr Surg. 2013; 132(3): 511-8[DOI][PubMed]
  • 14. Reish RG, Damjanovic B, Austen WG, Winograd J, Liao EC, Cetrulo CL, et al. Infection following implant-based reconstruction in 1952 consecutive breast reconstructions: salvage rates and predictors of success. Plast Reconstr Surg. 2013; 131(6): 1223-30[DOI][PubMed]
  • 15. Wang F, Peled AW, Chin R, Fowble B, Alvarado M, Ewing C, et al. The Impact of Radiation Therapy, Lymph Node Dissection, and Hormonal Therapy on Outcomes of Tissue Expander-Implant Exchange in Prosthetic Breast Reconstruction. Plast Reconstr Surg. 2016; 137(1): 1-9[DOI][PubMed]
  • 16. Hammond DC. Latissimus dorsi flap breast reconstruction. Clin Plast Surg. 2007; 34(1): 75-82[DOI][PubMed]
  • 17. Burgic M, Bruant RC, Wilk A, Bodin F, Rifatbegovic A, Halilbasic E, et al. Complications following autologous latissimus flap breast reconstruction. BJBMS. 2010; 10(1): 65-7
  • 18. Smith SL. Functional morbidity following latissimus dorsi flap breast reconstruction. J Adv Pract Oncol. 2014; 5(3): 181-7[PubMed]
  • 19. Adams WP, Lipschitz AH, Ansari M, Kenkel JM, Rohrich RJ. Functional donor site morbidity following latissimus dorsi muscle flap transfer. Ann Plast Surg. 2004; 53(1): 6-11[PubMed]
  • 20. Spear SL, Hess CL. A review of the biomechanical and functional changes in the shoulder following transfer of the latissimus dorsi muscles. Plast Reconstr Surg. 2005; 115(7): 2070-3[PubMed]
  • 21. Losken A, Nicholas CS, Pinell XA, Carlson GW. Outcomes evaluation following bilateral breast reconstruction using latissimus dorsi myocutaneous flaps. Ann Plast Surg. 2010; 65(1): 17-22[DOI][PubMed]
  • 22. Ilfeld BM, Madison SJ, Suresh PJ, Sandhu NS, Kormylo NJ, Malhotra N, et al. Persistent postmastectomy pain and pain-related physical and emotional functioning with and without a continuous paravertebral nerve block: a prospective 1-year follow-up assessment of a randomized, triple-masked, placebo-controlled study. Ann Surg Oncol. 2015; 22(6): 2017-25[DOI][PubMed]
  • 23. Kairaluoma PM, Bachmann MS, Rosenberg PH, Pere PJ. Preincisional paravertebral block reduces the prevalence of chronic pain after breast surgery. Anesth Analg. 2006; 103(3): 703-8[DOI][PubMed]
  • 24. Boughey JC, Goravanchi F, Parris RN, Kee SS, Kowalski AM, Frenzel JC, et al. Prospective randomized trial of paravertebral block for patients undergoing breast cancer surgery. Am J Surg. 2009; 198(5): 720-5[DOI][PubMed]
  • 25. Fahy AS, Jakub JW, Dy BM, Eldin NS, Harmsen S, Sviggum H, et al. Paravertebral blocks in patients undergoing mastectomy with or without immediate reconstruction provides improved pain control and decreased postoperative nausea and vomiting. Ann Surg Oncol. 2014; 21(10): 3284-9[DOI][PubMed]
  • 26. Ilfeld BM. Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg. 2011; 113(4): 904-25[DOI][PubMed]
  • 27. Ilfeld BM, Madison SJ. Continuous paravertebral blocks for analgesia following mastectomy: the jury is still out. Reg Anesth Pain Med. 2014; 39(4): 355[DOI][PubMed]
  • 28. Surange PN, Venkata Rama Mohan BC. Comparative evaluation of continuous lumbar paravertebral versus continuous epidural block for post-operative pain relief in hip surgeries. Anesth Pain Med. 2012; 1(3): 178-83[DOI][PubMed]
  • 29. Ilfeld BM, Madison SJ, Suresh PJ, Sandhu NS, Kormylo NJ, Malhotra N, et al. Treatment of postmastectomy pain with ambulatory continuous paravertebral nerve blocks: a randomized, triple-masked, placebo-controlled study. Reg Anesth Pain Med. 2014; 39(2): 89-96[DOI][PubMed]
  • 30. Imani F, Faiz HR, Sedaghat M, Hajiashrafi M. Effects of adding ketamine to fentanyl plus acetaminophen on postoperative pain by patient controlled analgesia in abdominal surgery. Anesth Pain Med. 2014; 4(1): 12162[DOI][PubMed]
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