185 Safety and efficacy of regional anesthesia alone for patients undergoing breast surgery; a qualitative review

Breast cancer and subsequent breast surgery is prevalent in North America. General anesthesia (GA) is the standard anesthetic choice despite being associated with postoperative complications. Regional anesthesia (RA) offers an alternative anesthetic choice. This study aimed to qualitatively review the literature on efficacy of RA alone for breast surgery. OVID and EMBASE databases were searched for articles pertaining to the use of regional anaesthesia alone for breast surgery up to June 2021. Systematic review was conducted according to PRISMA guidelines. 24 studies were reviewed encompassing various RA blocks (paravertebral (PVB), pectoralis (PECS), thoracic and cervical epidural blocks (TEA, CE)). PVB represented 42% of studies. Mean patient age was from 54.8 – 72.6, most (65%) were ASA class 2–3. Two studies found the RA group had significantly less pain 24h after surgery, compared to GA.1,2 Similarly, opioid and morphine equivalent requirements were significantly higher for GA compared to RA in two studies.3,4 One study reported lower prevalence of pain in the TEA group versus GA. 3 Patients in the RA group had significantly less postoperative nausea/vomiting versus their GA counterparts, and greater level of patient satisfaction in two studies.2,4 Rate of conversion to GA was 0% (95% CI [0%-3%]). No significant difference between length of stay or days till resumption of diet was found. There is substantial data to support the effectiveness of PVB as an alternative to GA for breast surgery. Such data was limited for PECS blocks, further studies evaluating efficacy of these blocks is warranted.