{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T02:48:47Z","timestamp":1788922127587,"version":"build-2803163510"},"reference-count":30,"publisher":"BMJ","issue":"4","funder":[{"name":"NIH\/NCI","award":["Center Support Grant P30 CA008748"],"award-info":[{"award-number":["Center Support Grant P30 CA008748"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2024,1,20]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Autologous breast reconstruction is associated with significant pain impeding early recovery. Our objective was to evaluate the impact of replacing surgeon-administered local infiltration with preoperative paravertebral (PVB) and erector spinae plane (ESP) blocks for latissimus dorsi myocutaneous flap reconstruction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients who underwent mastectomy with latissimus flap reconstruction from 2018 to 2022 were included in three groups: local infiltration, PVB, and ESP blocks. Block effect on postoperative length of stay (LOS) and the association between block status and pain, opioid consumption, time to first analgesic, and postoperative antiemetic administration were assessed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>122 patients met the inclusion criteria for this retrospective cohort study: no block (n=72), PVB (n=26), and ESP (n=24). On adjusted analysis, those who received a PVB block had a 20-hour shorter postoperative stay (95%\u2009CI 11 to 30; p&lt;0.001); those who received ESP had a 24-hour (95%\u2009CI 15 to 34; p&lt;0.001) shorter postoperative stay compared with the no block group, respectively. Using either block was associated with a reduction in intraoperative opioids (23 morphine milligram equivalents (MME)), 95%\u2009CI 14 to 31, p&lt;0.001; ESP versus no block: 23 MME, 95%\u2009CI 14 to 32, p&lt;0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Replacing surgical infiltration with PVB and ESP blocks for autologous breast reconstruction reduces LOS. The comparable reduction in LOS suggests that ESP may be a viable alternative to PVB in patients undergoing latissimus flap breast reconstruction following mastectomy. Further research should investigate whether ESP or PVB have better patient outcomes in complex breast reconstruction.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2023-105031","type":"journal-article","created":{"date-parts":[[2024,2,9]],"date-time":"2024-02-09T13:05:49Z","timestamp":1707483949000},"page":"339-344","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Paravertebral and erector spinae plane blocks decrease length of stay compared with local infiltration analgesia in autologous breast reconstruction"],"prefix":"10.1136","volume":"50","author":[{"given":"Haripriya S","family":"Ayyala","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Assel","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Aloise","sequence":"additional","affiliation":[{"name":"Department of Operational Excellence, Memorial Sloan Kettering Cancer Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Serafin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kay See","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghana","family":"Mehta","sequence":"additional","affiliation":[{"name":"Digital Informatics & Technology Solutions Department, Memorial Sloan Kettering Cancer Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinay","family":"Puttanniah","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7062-2409","authenticated-orcid":false,"given":"Patrick","family":"McCormick","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Vickers","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Matros","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9765-0946","authenticated-orcid":false,"given":"Emily","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,2,8]]},"reference":[{"key":"2025101110452236000_50.4.339.1","doi-asserted-by":"crossref","DOI":"10.1097\/GOX.0000000000002382","article-title":"Latissimus dorsi musculocutaneous flap for complex breast reconstruction: indications, outcomes and a proposed algorithm","volume":"7","author":"Kokosis","year":"2019","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"2025101110452236000_50.4.339.2","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1097\/SLA.0000000000000908","article-title":"Patient-reported quality of life and satisfaction with cosmetic outcomes after breast conservation and mastectomy with and without reconstruction: results of a survey of breast cancer survivors","volume":"261","author":"Jagsi","year":"2015","journal-title":"Ann Surg"},{"key":"2025101110452236000_50.4.339.3","doi-asserted-by":"crossref","first-page":"S185","DOI":"10.1097\/SAP.0000000000001079","article-title":"Latissimus dorsi flap breast reconstruction-a nationwide inpatient sample review","volume":"78","author":"DeLong","year":"2017","journal-title":"Ann Plast Surg"},{"key":"2025101110452236000_50.4.339.4","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1016\/j.bjps.2020.11.047","article-title":"Enhanced recovery after breast reconstruction with a pedicled latissimus dorsi flap-a prospective clinical study","volume":"74","author":"H\u00f8jvig","year":"2021","journal-title":"J Plast Reconstr Aesthet 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