Efficacy of pectoralis nerve blocks I & II with liposomal bupivacaine in patients undergoing elective breast reduction procedures: A retrospective study

Background: The pectoral nerve (PECs) block I and II nerve blocks with liposomal bupivacaine (LB, Exparel) are used for postoperative analgesia in breast surgery, but evidence on efficacy for breast reduction is limited. We examined the effect of the PECS I and II blocks with LB on perioperative opioid use and pain scores compared to no block and blocks with plain local anesthetic (LA). We hypothesized that patients receiving a block with LB would require lower opioid amounts. Methods: This retrospective cohort analysis included 120 patients undergoing breast reduction from 2011-2023. Patients received: no block, PECs block with plain LA, or PECs block with LB. Primary outcomes were intraoperative, Post-Anesthesia Care Unit (PACU), and outpatient opioid requirements. The secondary outcomes were PACU pain scores. Results: Forty patients had no block, twenty-six received plain LA block, and fifty-four received LB block. For intraoperative opioids, LB block significantly lowered use compared to no block. PACU opioid use showed no differences between groups. For outpatient opioids, both LB and plain LA blocks significantly lowered use compared to no block. No significant pain score differences were found between groups. Conclusions: Patients receiving the PECS block had decreased outpatient narcotic requirements compared to those patients who did not get the block. Patients receiving PECS block with LB had the further benefit of having decreased intraoperative narcotic requirements compared to the other groups. This highlights the potential benefit of performing the PECS block for patients undergoing breast reduction surgery. (c) 2024 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)