Background: Breast augmentation is among the most popular surgery procedures performed in the Asian countries. Subpectoral
augmentation involves additional pain from muscle spasm following muscle dissection. Adequate pain control can have a substantial impact on morbidity and patient satisfaction. To date, no standard of care exists and management is based on surgeon preferences. The purpose of our study is to examine the role of intercostal nerve block and local bupivacaine injection in pain management following subpectoral breast augmentation.

Objective: To study the effect of field block and intercostal nerve block on postoperative pain in augmentation mammoplasty patients.

Materials and Methods: This study was a prospective, randomized, placebo controlled, double blinded clinical trial with ethical approval. Thirty-two consecutive women undergoing subpectoral breast augmentation were enrolled. Patient received general anesthesia and were allocated randomly to two study groups. Patient in group 1 received intercostal nerve block using 10 ml of 0.25% bupivacaine with epinephrine in one side of breast and normal saline in another side prior to implant placement. Patient in group 2 received locally administered 20 ml of 0.25% bupivacaine with epinephrine in one side of breast and placebo infiltration of normal saline in the contralateral breast. Primary outcome was pain measured with the visual analogue scale recorded at 2, 6, 12, 24 and 48 hours at rest and after movement. A p-value of <0.05 was considered statistically significant.

Results: Postoperative pain gradually decreased with time in all patients. By comparing analgesic outcomes in the same patients, we
could control for the subjectivity of pain assessments. No difference in pain scores was found over time at rest or on movement when comparing intercostal nerve block to placebo or local infiltration to placebo. There were no significant complications.

Conclusion: No statistically significant difference in postoperative pain when comparing those receiving intercostal nerve block versus placebo and those receiving local administered bupivacaine versus placebo.

Keywords: Breast augmentation, Postoperative pain, Subpectoral breast augmentation, Intercostal nerve block, Field local anesthetic
infiltration