RESUMO
Background: The purpose of our study is to evaluate the role of intercostal nerve block and pectoralis major muscle infiltration in postoperative pain management following subpectoral breast augmentation
Methods : This is a prospective randomized controlled study using patients as their own controls. Women undergoing primary bilateral subpectoral breast augmentation from July 2012 until July 2013 were enrolled and randomly allocated to two cohorts. Both cohorts received pectoralis major muscle infiltration using 20 mL of 0.25% bupivacaine with epinephrine on one breast. The contralateral breast was treated with intercostal nerve block in cohort 1, and with a placebo infiltration of the pectoralis major muscle in cohort 2. The 10-point Visual Analog Scale was used postoperatively on each breast at 0, 1, 3, 8 and 24 hours at rest and after movement. The change in pain score difference over time was analyzed with a mixed effect linear regression model
Results : Cohort 1 and 2 consisted of 13 and 15 patients respectively. Pectoralis major muscle infiltration and intercostal nerve block were easily performed and no complications were reported. When comparing pectoralis major muscle infiltration to intercostal nerve block, there was no difference in pain on admission to the recovery room at rest [p = 0.98], or after movement [p = 0.79]. Postoperative pain gradually decreased with time and no difference in pain was found across time at rest [p = 0.91], or on movement [p = 0.92]. The comparison of pectoralis major muscle infiltration to placebo yielded similar results with no difference in pain on admission or across time
Conclusion: Intercostal nerve block and pectoralis major muscle infiltration do not offer any significant analgesic benefit following breast augmentation