Microvascular Breast Reconstruction: Medical center in Minnesota
- 49 adult patients undergoing microvascular breast reconstruction with EXPAREL as part of an ERAS protocol compared with 51 adult patients undergoing microvascular breast reconstruction with TRAS before development of the ERAS protocol
- Retrospective cohort study
- Characteristics were compared between the 2 groups, and a multivariable regression analysis was used on continuous outcome variables to account for baseline differences between the 2 groups
- No significant differences between the 2 groups in relation to 30-day complications
- The ERAS group experienced an increased incidence of native breast skin flap cellulitis compared with the group without ERAS (20% vs 6%, respectively; P=0.03)
Clinical and Economic Outcomes
In patients who received EXPAREL for analgesia
better pain control
(P=0.02) 24 hours postsurgery*
- 24 hours: 3.3 vs 4.1 (P=0.02)
- Total: 167.3 vs 574.3 (P<0.001)
- Day 1: 67.3 vs 260.9 (P<0.001)
- Day 2: 53.5 vs 192.2 (P<0.001)
- Day 3: 39.0 vs 113.1 (P<0.001)
shorter LOS postsurgery
- Total: 3.9 vs 5.5 days (P<0.001)
*All pain was measured using the visual analog scale.
†Parenteral and oral opioid intake was converted into oral morphine equivalents (mg) using standardized calculations.
‡The clinical benefit of the decrease in opioid consumption was not demonstrated in the clinical trials.
ERAS, enhanced recovery after surgery; TRAS, traditional recovery after surgery; LOS, length of stay.