The Effect of Pectoral Blocks on Perioperative Pain in Gender Affirmation Top Surgery
Condition: Gender Dysphoria; Opioid Use; Pain, Postoperative
MeSH terms: Pain, Postoperative; Gender Dysphoria
Intervention: Ropivacaine 0.2% Injectable Solution; Saline (0.9%)
Intervention description: Ropivacaine 0.2% Injectable Solution injected as part of the Pectoralis Nerve Block; Saline injection as sham block in identical fashion as Pectoralis Nerve Block
Intervention MeSH terms: Ropivacaine
Phase: Phase 4
Study type: Interventional
Primary purpose: Prevention
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Enrollment: 50.0
Sex: All
Minimum age: 18 Years
Maximum age: 65 Years
Healthy volunteers: No

Summary:

      Despite recent advancements with regional and local anesthesia, postoperative pain continues
      to be a major concern for patients undergoing breast surgery. Opioids, often in combination
      with NSAIDS and/or gabapentioids, have been the main pharmacologic pain control strategy in
      the postoperative period. The pectoral nerve block is a regional anesthetic technique, which
      is effective at providing postoperative anesthesia in breast surgeries. However, this has
      only been studied in oncologic-related breast operations. It is our aim to study the effects
      of pectoral regional nerve blocks in patients undergoing breast reduction for gender
      affirmation. The overall goal is to establish an effective pain control regimen utilizing
      regional anesthetic techniques in this patient population. The specific objective of this
      proposal is to evaluate the effectiveness of these blocks on perioperative and postoperative
      analgesia. The hypothesis is that participants undergoing gender-affirmation breast surgery
      who receive a pectoral nerve block will have less perioperative and postoperative pain as
      well as reduced opioid consumption compared to those receiving a placebo. Participants who
      are undergoing gender affirmation breast reduction surgery will be randomized to either
      receive a preoperative nerve block or to receive a placebo. Intraoperative and postoperative
      opioid requirements will be compared in addition to post-operative pain scores. Participants
      will be asked to fill out a pain diary during their first week postoperatively. They will
      also be asked to document if, and when, narcotic pain medication was required for pain
      control. The two groups will be compared to determine if there was any difference in pain
      scores as well as narcotic medication requirements.
    

Eligibility criteria:

        Inclusion Criteria:

          -  American Society of Anesthesiologists (ASA) class I-III

          -  Ages 18-65

          -  Undergoing gender confirmation breast reduction surgery by a single surgeon at a
             single center

        Exclusion Criteria:

          -  Previous breast surgeries

          -  Current breast cancer or history of treatment for breast cancer

          -  Current chronic pain syndromes

          -  Coagulopathy

          -  Allergy to local anesthetics

          -  Infection at the injection site