P243 Do paravertebral and erector spinae plane blocks improve pain outcomes in day case breast surgery? An initial audit to inform quality improvement

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Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Background and Aims There is growing evidence showing paravertebral (PVB) or erector spinae (ESP) plane blocks provide better post-operative analgesia, reduced length-of stay, reduced opioid consumption when compared with other analgesic options, in the context of major breast surgery. At our centre, we perform 160 mastectomies annually, with approximately 50% receiving PVB or ESP block. Our aim was to conduct a baseline audit of our current practice to quantify post-operative pain outcomes. This would then inform implemented change, with the aim of improving pain outcomes following breast surgery. Methods Over a 3-month period, we audited 20 patients undergoing mastectomy or mammoplasty. 10 patients received general anaesthesia (GA) with PVB or ESP block. 10 received GA with local anaesthesia infiltrated surgically. Data was gathered both prospectively and retrospectively. Our local audit department authorised this project confirming it did not require Ethical Committee approval. The key outcomes audited were - failed day case rate, intra and post-operative opioid requirement and pain scores immediately after surgery, on discharge, day 1 and day 2. Conclusions Our data shows that patients undergoing mastectomy or mammoplasty that received PVB or ESP block had reduced intra and post-operative opioid requirements, reduced pain scores up to 48 hours post-operatively as well as being less likely for day case failure due to inadequate analgesia. After achieving our aim from this initial audit, we will present this data at our departmental clinical governance meeting. Our recommendations for change will include PVB and ESP block training, following which we plan to re-audit to measure any improvement.

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