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The following is a summary of “Multiple intramuscular ropivacaine injection to donor sites reduces pain in deep inferior epigastric artery perforator flap breast reconstruction,” published in the August 2024 issue of Surgery by Bae et al.

Local anesthetic infiltration at the surgical site has been extensively studied across various surgical disciplines, yet its specific impact on donor-site pain in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction has not been previously examined. This study sought to assess the effectiveness of multiple intramuscular ropivacaine injections in alleviating donor site pain during DIEP flap breast reconstruction.

This study involved 65 patients who received local ropivacaine injections during DIEP flap reconstructions from March 2022 to February 2023, compared with 55 patients who underwent similar procedures without ropivacaine from October 2018 to July 2020. A total of 20 cc of 0.75% ropivacaine solution was uniformly administered across 20 sites along the abdominal wall muscles. The impact of these intramuscular injections on postoperative pain was evaluated using visual analog scale (VAS) scores and analyzed with a linear mixed-effects model. Additionally, opioid consumption and length of hospital stay were compared between the two groups.

Patients receiving ropivacaine reported significantly lower median daily VAS scores compared to those who did not receive the anesthetic (all p-values < 0.001). The linear mixed-effects model analysis demonstrated that VAS scores were consistently lower for the ropivacaine group during the first five postoperative days (p-value < 0.001). Moreover, the rate of VAS score decline was notably faster in the ropivacaine group during the first 24 hours postoperatively (p-value = 0.045). Although opioid consumption did not differ significantly between the two groups, the ropivacaine group experienced substantially shorter hospital stays (p-value = 0.001), and no complications related to the injections were reported.

The administration of multiple intramuscular ropivacaine injections at the donor site in DIEP flap breast reconstruction is associated with reduced postoperative pain and a shorter hospital stay without increasing opioid consumption. This approach provides a beneficial adjunct to pain management strategies in this surgical context.

Source: sciencedirect.com/science/article/abs/pii/S1748681524005023