Anesthesia & Breast Reconstruction

MUSC Health has an outstanding anesthesia team whose members are focused on the best possible anesthesia care for your upcoming breast surgery. From the time you enter the MUSC Health system you will be identified as a preferred breast care patient. Our team will optimize your anesthetic preparation, anesthetic plan, and post-operative pain control strategy. Efforts will be made to have your preferences incorporated into the care plan, when appropriate, and your individual medical and emotional needs will be considered in a focused anesthetic experience. The most advanced technologies, supported by our world famous research facility, will be used to your advantage. In short, you will be receiving the most modern and personalized care available.

On the day of surgery, you will be asked to arrive two hours before your scheduled surgery time. Following registration you will be escorted to our preoperative holding area. There, you will be greeted by one of our excellent preoperative nurses who will prepare you for the operating room. You will also meet your anesthesia team. This team is comprised of a board certified anesthesiologist and either a certified registered nurse anesthetist or an anesthesiology resident. We will interview you to confirm your medical history so that we may tailor the anesthetic to your individual needs. Once in the operating room, you will receive medication through your IV and general anesthesia will be induced. Throughout the entire surgical period, we will continuously monitor and support your body, keeping you safe and comfortable, while providing optimum conditions for your surgical procedure. When your surgery is complete and you have awakened from anesthesia, we will transport you to the Post Anesthesia Care Unit (PACU). There, you will be monitored for pain, nausea, or any other issues until you are feeling comfortable and ready to go to your hospital room.

Breast surgery has a very high incidence (sixty to eighty percent) of postoperative nausea and vomiting (PONV). There are multiple risk factors that contribute to the likelihood of anesthesia-related nausea and vomiting such as a history of motion sickness and a previous experience of PONV. The anesthesia providers will assess for these risk factors and others to determine the best anesthetic approach to minimize the incidence of PONV.

Your recovery and care following surgery is equally important. Management of postoperative pain and nausea is an integral part of breast reconstruction surgery. At MUSC Health, we use a multimodal approach to control postoperative discomfort. This approach includes the administration of opiates, local anesthetics, non-steroidal anti-inflammatory (NSAID) medication, acetaminophen, and anti-nausea medications. These medications along with specialized anesthesia techniques used during surgery aim to minimize pain and nausea during your recovery period.

Postoperative Pain Management Treatment Options

Medications

Several types of medications are available for the management of postoperative pain. Examples include:

• Opiates, ex. Morphine, Dilaudid, Percocet, Lortab
• Non-steroidal Anti-inflammatory Drugs (NSAIDs), ex. Toradol
• Acetaminophen (Tylenol)

Intravenous opiates, such as Morphine or Dilaudid are typically administered through a patient-controlled device allowing you to self administer a predetermined amount of medication. These are changed to oral medications as your recovery progresses.

Thoracic Paravertebral Nerve Block

The thoracic paravertebral nerve block is a technique whereby a local anesthetic is injected in the vicinity of nerves emerging from the spinal column in the thoracic region. It results in anesthesia and analgesia to the chest wall area.

This particular nerve block is most commonly performed for patients undergoing breast (mastectomy and cosmetic breast surgery) and thoracic surgery. It can be administered to one or both sides of the body and the specific location and distribution of anesthesia and analgesia are a function of the level blocked and the amount of local anesthetic injected. Also, a catheter can also be inserted for continuous infusion of local anesthetic.

With paravertebral nerve blocks, the potential side effects of general anesthesia such as postoperative nausea and vomiting are avoided and patients often feel little or no pain. Any existing pain can be easily managed with medications. These nerve blocks do not result in loss of motor function and thus, do not impair a patient's ability to ambulate or care for herself following surgery. In addition, the injection of small amounts at several levels decreases the risk for local anesthetic toxicity.

Several local anesthetics can be used. However, the use of a long-acting local anesthetic provides the greatest benefit for pain relief. A commonly used local anesthetic, 0.5 percent Ropivacaine, has an onset time of 15 to 25 minutes and provides analgesia for 8 to 12 hours.

Continuous Wound Infusion

For patients whose surgery involves the abdomen, the surgeon may place a device, such as an On-Q pain pump, to administer a low dose local anesthetic continuously near the incision site. With this system, the infusion pump administers the medication through small catheters that are placed at the incision site by the surgeon near the end of surgery. When used to deliver local anesthetics to or around the surgical wound site, this type of device can significantly decrease postoperative pain and narcotic use and can be used for many days, even at home.