Nerve Blocks in Reduction Mammaplasty: A Systematic Review and Meta-analysis of Pain Outcomes.

[INTRODUCTION] Postoperative pain can delay recovery following reduction mammaplasty (RM). While nerve blocks (NBs) are widely used in other surgeries, their efficacy in RM remains underexplored. This study evaluates the impact of perioperative NB on pain management and opioid use after RM.

[METHODS] A systematic review was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pubmed, Embase, SCOPUS, and Cochrane databases were queried for studies on NB in RM. NB type and outcomes, including postoperative pain, opioid consumption, and rescue analgesia, were extracted. Meta-analysis was performed using a random-effects model and inverse-variance methods to calculate mean differences (MDs).

[RESULTS] Seven studies with 330 patients were included, of whom 53.6% (n = 177) received NB. Six studies used saline negative controls, and one compared drug compositions. NB significantly reduced postoperative pain at 1 h (MD -2.00, P < 0.001), 4 h (MD -1.86, P < 0.001), 6 h (MD -2.13, P = 0.005), and 12 h (MD -1.89, P < 0.001), but not at 24 h (MD -0.78, P = 0.12). NB also reduced intraoperative (MD -8.51, P = 0.02) and 24-h postoperative opioid use (MD -7.55, P < 0.001). The need for rescue analgesia was reduced by 96% following NB (odds ratio 0.04, P < 0.001). No difference in pain reduction at 1 h was found between NB types (P = 0.81, I = 0%).

[CONCLUSIONS] NBs significantly reduce early postoperative pain and opioid use in RM, with no differences observed between NB types.