Pre-surgical nerve block & post-op pain

quaydvt

I have seen a number of posts on nerve blocks in a number of different threads / topics / forums but thought it might be a good idea to try to get everyone's experiences in one place for those who still have to go.

There will always be a range of experience with post op pain just because we are all different.

I would like to hear from those who did have vs those who did not have a PRE-surgical nerve block (paravertebral or pecs) and how your post op pain control went for you.

I also see that some got a nerve block post surgery (when it isn't as effective because it isn't preventative/pre-emptive)

I just had BMX on Monday with presurgical pectoral nerve block and have had no pain. A little discomfort especially if I overdo it, but nothing remotely resembling pain. They gave me an IV hydromorphone dose (which I didn't need, they didn't ask aboutand just made me sick for 36 hours!) And I have used very little in the way of post op meds. Took half the dose of tramadol/acet for one day, Tylenol for one more and now nothing.

I would love for us to be able to help those still ahead on the surgery schedule advocate for their own pain control and speak to their anesthesiologist about pre-emptive nerve blocks. Also cuts down on the amount and kind of general anesthetic needed!!

BellasMomToo

I had a UMX & SNB. As far as I know, I didn't receive any nerve block (pre or post). I had very little pain. I was in the hospital for one night. During that stay, I only had Norco twice. When I came home, I took Norco that evening After that, I took tylenol for when I experienced (mild) discomfort.

About two weeks after my surgery, I started having pain. More pain than right after surgery. I think the nerves were regenerating and the pain was a tingling sensation. But tylenol helped with that pain and the pain has since subsided. It's still sensitive, but it has improved.

candles1

I had the nerve block before my BMX/reconstruction and had zero pain afterward. Zero. I highly, highly recommend speaking to your anesthesiologist about this option.

Importantly, my anesthesiologist informed me that there is evidence that the presurgical nerve block has been shown to reduce breast cancer recurrence. It has something to do with reducing the body's natural inflammatory response to pain (since the nerves are never "informed" that there IS any pain). This alone is an excellent reason to inquire about this method of anesthesia.

SummerAngel

It's also important to note that the placement of tissue expanders at the time of mastectomy tends to greatly increase post-op pain. I had paravertebral block pre-surgery and a lot of post-op pain. I couldn't say if the block helped at all. The TEs caused me a lot of misery, my PS seems to think that really those with very strong pecs have a harder time with TEs. I like to think that's why, because one of my favorite exercises pre-BMX was pushups.

lrwells50

I had a BMX on 3/8, which took about 45 minutes, then the plastic surgeon put in tissue expanders, and his part took 4-5 hours. I didn't t really have any pain unless I moved too quickly. They used Exparel on me, which is an analgesic that they put in the wound, which lessens the need for opiates. I left to go home about 7 pm the next night. Could have left earlier, but had to wait for the doc. We had a 2 hour drive home, but I had no problems. One of my daughters was here for two weeks to run errands and cook, and I have a bed that raises and lowers, so I did pretty well. The worst part was sleeping on my back. I think I probably used more Tylenol 3 just because I couldn't sleep easily.

I worked at home some the second and third week, but went to the office after I finally got the drains out. I could have probably worked at the office the third week, but I still had my drains, and one of them leaked, which was the biggest PIA about the whole thing.

I haven't had any problems with moving my arms, and the PS has put 360 ccs in each expander. Last week was really the first time it felt tight, but when I go again on Monday, I'm thinking it may be uncomfortable if he puts in 120 like he has been.

Because my cancer turned out to be lobular (didn't know until the labs after the surgery,) and my Oncotype score was 24, I'll start chemo week after next. Trying the Paxman Scalp Cooling system - hope I can handle it.

quaydvt

BellasMomToo - Thank you. Happy to hear!! I wanted to get this thread going to see everyone's experience in one place instead of piecemeal all over. I'm in the middle of week 2 and still not having any pain - the odd phantom twinge and bruised here and there, but still not painful, and no tingling, burning as I have read some have experienced.

Summerangel - I know that sometimes the nerve blocks don't work as well as intended. But I guess it's hard to say whether it would have been much worse (b/c of the TEs) or if it just wasn't effective for you. Good to know though!

Irwells50 - thanks for that info. My BS told me about them possibly infusing a local through the drains after placement, but she wasn't sure whether the anesthesiologist would be doing a pre-surgical block. I was frankly hoping for both

Candles1 - I also read that about the possible decrease in recurrence.

I think, for me, the fact that there is really almost no downside - especially with a pectoral block - and the huge upside, there is no reason NOT to really lobby for a pre-surgical (and possibly post-surgical like Irwells50 had) nerve-block.

There is NO upside to pain - the old adage that it keeps you from overdoing it, forces you to rest and repair, is crap. Pain delays healing - all of the hormones and mediators it releases slows down the physical healing mechanism (stress hormones) and although you may not move around a lot, you definitely WON'T rest - hard to relax & get quality sleep when everything hurts every time you shift or breathe.

flannelette2

I had the paravertebral pre-surgery block in 2008 for my MX and experienced no pain. Ever. I did not bother with reconstruction so had no issue expanders. Best thing that could have happened. I knew nothing about it, pre-surgery. But on my guerney, waiting, in bops the young anesthetist who informs me I can have this & will LOVE it and at that time not all aneshetists knew how but he'd just come from training for breast surgery pain management so I said yes.

WOW! So, even being given the block, when I had to sit up while they did it, it felt like nothing and by then you're so stoned you think you can do the surgery yourself so I enjoyed looking around the operating room (though I'd been crying as they'd wheeled me down the hall).

The nurse asked me, later, in my room around midnight if i wanted a morphine injection just in case so I said yes, not having a clue, but i know I didn't need it and not once, ever, to this day, did i have to take so much as 1 tylenol for pain. EVER.

I cannot recommend it highly enough and feel so lucky and blessed that this just randomly happened to me the day of my MX. I cannot imagine turning it down if offered.