Hinson Chandler S, Masters Hallie, Hu MengJie, Michaels Benjamin, Beyers Matthew, Brooks Ronald M
From the Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL.
Plastic and Reconstructive Surgery Clinic, University of South Alabama Health, Mobile, AL.
Plast Reconstr Surg Glob Open. 2025 Jun 16;13(6):e6900. doi: 10.1097/GOX.0000000000006900. eCollection 2025 Jun.
Macromastia causes significant physical and emotional distress. Reduction mammoplasty often requires opioid analgesia. This study compared the efficacy of combining an erector spinae plane (ESP) block with a field block of long-acting bupivacaine (LLAB) versus LLAB alone in managing pain and opioid use during breast reduction surgery.
We conducted a retrospective review of breast reduction patients from March 2021 to March 2022 at an academic center. The variables included specimen weights, liposuction volume, opioid use (standardized to morphine milligram equivalents [MME]), and pain scores (0-10 scale). Two-sample tests were used to assess significance.
Ninety-eight patients were analyzed: 50 received ESP blocks with LLAB, and 48 received LLAB alone. The ESP block group had significantly lower perioperative opioid use (33.5 versus 89.8 MME, < 0.001). Preoperative opioid use was similar (27.8 versus 31.5 MME, = 0.16). Postoperative opioid use trended lower in the ESP block group (22.5 versus 31.4 MME, = 0.06). ESP block patients also reported lower postanesthesia care unit pain scores (4.3 versus 6.0, < 0.001) and fewer postdischarge pain medication refills (12.0% versus 20.8%, = 0.02).
ESP blocks with LLAB reduced perioperative opioid use, immediate postoperative pain, and the need for postdischarge refills compared with LLAB alone. Although postoperative opioid reduction was not statistically significant, a clear trend was observed. These findings support further evaluation and potential adoption of the ESP block in breast reduction procedures.
巨乳症会导致严重的身体和情绪困扰。缩乳术通常需要使用阿片类镇痛药。本研究比较了竖脊肌平面（ESP）阻滞联合长效布比卡因（LLAB）局部阻滞与单纯使用LLAB在缩乳手术中控制疼痛和阿片类药物使用方面的疗效。
我们对2021年3月至2022年3月在一家学术中心接受缩乳手术的患者进行了回顾性研究。变量包括标本重量、吸脂量、阿片类药物使用情况（以吗啡毫克当量[MME]标准化）和疼痛评分（0至10分）。采用双样本检验评估显著性。
共分析了98例患者：50例接受了ESP阻滞联合LLAB，48例单纯接受LLAB。ESP阻滞组围手术期阿片类药物使用量显著更低（33.5对89.8 MME，P<0.001）。术前阿片类药物使用情况相似（27.8对31.5 MME，P = 0.16）。ESP阻滞组术后阿片类药物使用量有降低趋势（22.5对31.4 MME，P = 0.06）。接受ESP阻滞的患者在麻醉后恢复室的疼痛评分也更低（4.3对6.0，P<0.001），出院后疼痛药物补充剂的需求也更少（12.0%对20.8%，P = 0.02）。
与单纯使用LLAB相比，ESP阻滞联合LLAB减少了围手术期阿片类药物的使用、术后即刻疼痛以及出院后补充药物的需求。尽管术后阿片类药物减少量无统计学显著性，但观察到了明显趋势。这些发现支持在缩乳手术中进一步评估并可能采用ESP阻滞。
