Deep Inferior Epigastric Perforator Flap (D.I.E.P) for Breast Reconstruction: Impact of Intraoperative Intrathecal Morphine on Outcome

摘要

Background: Pain control after breast reconstruction with Deep Inferior EpigastricPerforator (DIEP) often requires intravenous narcotic analgesia and inpatient hospitalization.Intrathecal morphine (ITM) administration analgesia is increasing in popularity because itdecreases the use of intravenous analgesic medications and offer comparable pain relief withless systemic side effects. Questions/purposes: The aim of this retrospective study was toevaluate the effect of intrathecal morphine on postoperative morbidity of breast reconstructionby Deep Inferior Epigastric Perforator flap and compare it with intravenous narcotic analgesia.Methods: 269 patients underwent immediate or delayed DIEP reconstruction after mastectomy,by the same surgeon, at Jules Bordet Institute. Patients receiving ITM analgesia (300 ?) werematched 1:3 with patients undergoing intravenous narcotic analgesia for pain control in thesame years by the same surgeon. Differences in peri- and postoperative complications across thetwo groups were assessed. Results: The two groups were comparable in terms of demographiccharacteristics and factors of morbidity. Intraoperative variables were not statistically differentbetween the groups except for intraoperative blood loss (P = 0.0001), transfusion (P = 0.0001)and Intraoperative liquid requirement (p = 0.0001). Intra and postoperative blood pressure werelower in ITM group (p 0.05). Patients in ITM group showed lower postoperative analgesiarequirement (P 0,0001), less respiratory complications and less acute respiratory failure (P= 0,003 and P = 0,004, respectively). No statistically significant differences in the length ofhospital stay (LOS) were noted Conclusion: We found that intrathecal morphine analgesia wasassociated with less blood loss and fluid administration, better postoperative pain control, andless respiratory complications with an acceptable security profile than intravenous narcoticanalgesia. Clinical relevance: This study suggests that using intrathecal morphine may resultin less blood loss and blood transfusion, better postoperative pain control, and less respiratorycomplications.