INTRAPEC Technique Controls Pectoralis Spasm and Pain for Subpectoral Breast Implantation: A Retrospective Study.

BACKGROUND: In 2018, a novel approach to reduce pectoralis spasm from sub- pectoral breast implant surgery was published called the INTRAPEC.1 In this study, we more formally examine the effectiveness of the ultrasound-guided INTRAPEC injection to control postoperative pectoralis major spasm and pain following breast surgery with sub-pectoral implantation. METHODS: We employed a simple postoperative spasm and pain record to collect data on 17 patients, all of whom received INTRAPEC and erector spinae plane blocks as a part of an opioid- free anesthetic. All breast surgeries were completed with LMA general anesthesia, preserving spontaneous ventilation. RESULTS: Of the 17 study participants, 13 (76.4%) reported spasm scores less than 3 for the entire 2-day study period and, at most time points, patients reported a median score for pain of 2, with IQRs ranging from 1 to 7. CONCLUSIONS: The study results suggest that the INTRAPEC injection is a simple, low-cost, low-risk, and effective technique that controls post- operative spasm following breast surgery involving sub-pectoral implantation.

Effect of elective surgery on subjective health in veterans with chronic posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is common, is often chronic, and has been associated with greater risk of postoperative mortality in veterans. The purpose of this study was to determine if elective outpatient surgery had a persistent effect on the physical or mental health of veterans with chronic PTSD. A longitudinal, quasi-experimental study was conducted that followed up 60 veterans with chronic PTSD over 12 weeks. Self-reported physical and mental health, depressive symptom severity, and posttraumatic symptom severity were measured in 29 veterans undergoing outpatient elective surgery and 31 veterans not having elective surgery (controls). Data collection was performed at baseline and repeated 1, 4, and 12 weeks after surgery or enrollment. At baseline, both surgical and control subjects reported poor physical and mental subjective health status. After surgery, surgical group subjects reported mean age- and gender-adjusted reductions of 3.9 points on the Physical Component Summary score and 2.9 points on the Mental Component Summary score of the Veterans Rand 36-item Health Survey, which resolved by 4 weeks after surgery. These findings suggest that veterans with PTSD were at greater risk of mortality because of poor baseline health, but did not demonstrate persistent decline in health following common elective surgical procedures.

The perioperative implications of posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is an anxiety disorder that develops after exposure to a traumatic event and is characterized by symptoms of reexperiencing, emotional numbing, persistent arousal, and avoidance. Approximately 6.8% of the people in the United States will be diagnosed with PTSD at some point in their lives. The presence of PTSD in a surgical patient can be important because PTSD is associated with the use of psychoactive medications, risky health behaviors, cardiovascular comorbidities, depression, chronic pain, and cognitive dysfunction, all of which may influence the risk of perioperative morbidity and mortality. In addition, patients with PTSD are anxious around unfamiliar people and in unfamiliar environments. The purposes of this journal course are to provide anesthetists with a working knowledge of the symptoms, treatments, and comorbidities associated with PTSD and to suggest ways of interacting with patients with the disorder that increase trust and decrease the risk of evoking posttraumatic symptoms in the perioperative environment.