Authors: Angeletti C et al.
Cureus 18(2): e104300 10.7759/cureus.104300
Summary
This retrospective case series describes six adult women who underwent latissimus dorsi (LD) flap breast reconstruction (March 2022–December 2024) and received ultrasound-guided erector spinae plane block (ESPB) as the cornerstone regional technique, with selective addition of a parasternal intercostal plane (PIP) block when additional anterior chest wall coverage was anticipated. The authors report very low early pain scores (NRS 0 at rest immediately post-op for all patients), low dynamic pain scores through 48 hours (median dynamic NRS ≤3), and minimal opioid rescue (one patient received tramadol; others managed with non-opioid rescue as needed). No block-related complications or PONV were recorded, and all patients mobilized within 6–12 hours.
Mid-term follow-up was obtained by structured phone interview at 6 and 12 months. No patient reported persistent pain requiring ongoing analgesics; shoulder mobility was preserved in all, and satisfaction was high. One donor-site scar infection was reported and treated conservatively. The authors frame these results as feasibility and hypothesis-generating support for an ESPB-centered, anatomy-tailored fascial plane strategy for LD flap reconstruction, noting the dual pain generators (anterior chest/recipient site and posterior donor site) that make this operation different from many other breast procedures.
Key Points
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LD flap reconstruction produces pain at both the anterior breast/recipient site and the posterior donor site; a single anterior chest wall block may not be enough for both regions.
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In this six-patient series, ESPB (with selective PIP block) was associated with low early pain scores, very limited opioid rescue, no reported PONV, and early mobilization.
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Mid-term patient-reported outcomes were favorable: no ongoing analgesic requirement for persistent pain and preserved shoulder function, though objective functional testing was not performed.
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Evidence strength is limited by design: single-center, retrospective, n=6, no control group, heterogeneity in local anesthetic/adjuvants, and phone-based follow-up.
What You Should Know
If you’re considering opioid-sparing pathways for LD flap reconstruction, this paper supports a practical approach: ESPB as the “workhorse” posterior thoracic block, with an add-on anterior block (like PIP) when the surgical plan suggests meaningful parasternal/anterior chest wall pain. The signal is encouraging but should be treated as preliminary; a standardized protocol and comparative prospective studies would be needed to know whether ESPB (alone or combined) outperforms alternatives like paravertebral techniques, serratus anterior plane blocks, or local infiltration strategies in this specific reconstructive population.
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