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Pulsed Electromagnetic Field Therapy Versus Pectoral Interfascial Block For Tissue Expander Placement In Breast Reconstruction: A Placebo-controlled Randomized Controlled Trial
Dylan K. Kim, AB1, Matthew A. Wright, MD
1, Sherene Ishtihar, BS
1, Ronald R. Nelson, Jr., MD
2, Cheng-Shiun Leu, PhD
1, Anis Dizdarevic, MD
1, Danielle B. Ludwin, MD
3, Christine H. Rohde, MD MPH
1.
1Columbia University Irving Medical Center, New York, NY, USA,
2Duke University, Durham, NC, USA,
3Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Purpose: Postoperative pain is a well-described outcome after implant-based breast reconstruction. This study compares two perioperative interventions that have reduced postoperative pain and pain medication use in prior randomized controlled trials, pulsed electromagnetic field (PEMF) therapy and pectoral interfascial nerve blocks (PIB), following tissue expander placement.
Methods: This was a double-blinded, placebo-controlled, single-institution randomized controlled trial that enrolled patients undergoing tissue expander placement from 2017-2022 and divided participants into four groups: placebo, PEMF, PIB, or both PEMF and PIB. The primary outcome was postoperative pain, measured by the visual analog scale (VAS). Secondary outcomes included quality of recovery and total narcotic use. We used paired t-tests to assess within-group changes over time, and independent-sample t-tests to compare between-group differences.
Results: Among the study cohort of 60 patients, VAS scores significantly improved over 3 weeks postoperatively for all groups (
p<0.05). At 1 hour after surgery, PIB alone was associated with a lower VAS score compared to placebo (estimate: -2.3, SE: 1.1,
p=0.035). Otherwise, there was no significant difference in VAS scores at 1 hour, 1 day, 3 days, 1 week, and 3 weeks for all groups compared to placebo, as well as no significant difference for quality of recovery and narcotic use at 3 weeks (
p>0.05).
Conclusion: PEMF devices and PIB did not demonstrate significant improvements in postoperative pain from placebo. When compared to other procedures that received benefit from PEMF devices, differences in baseline postoperative pain or rate of recovery in tissue expander cases may contribute to these findings.
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