Analgesic approaches — educational dosing reference
Educational work by a pre-medical student — not medical advice. Not a clinical protocol, prescription, or patient handout, and not for patient care. See DISCLAIMER.
This folder holds three structured educational examples of anesthetic and analgesic approaches for post-mastectomy breast implant revision, plus a comparison. The historical filenames ("Protocol_…", "OFIA") are kept so existing links keep working. These documents are not clinical protocols or treatment pathways.
Numbers. The documents include doses, rates, maxima, intervals and thresholds. Each one is tagged, e.g. S14, to a society guideline, consensus statement, FDA label or score-validation paper listed in DOSING_SOURCES.md. The values are illustrative. They show what the source states, are not validated for this procedure, and must be individualized by the treating clinician under institutional policy. Off-label uses are marked.
| File | Approach | Main features |
|---|---|---|
| Protocol_1_OFIA_With_PECS_Block.md | 1 — regional block (PECS/serratus) + multimodal GA | Block-related early analgesia; one local-anesthetic budget; no IV lidocaine with blocks |
| Protocol_2_OFIA_BlockFree.md | 2 — systemic multimodal GA, no block | Surgeon infiltration as foundation; IV lidocaine not combined with infiltration; avoid sedative stacking |
| Protocol_3_OpioidBased_NoBlocks.md | 3 — opioid-inclusive balanced GA | Opioid stewardship, label-based rescue and naloxone values, PONV prophylaxis |
| Protocol_Comparison_Table.md | Comparison | Side-by-side features, adjunct dose summary, selection considerations |
The numbering does not imply preference or an escalation sequence. No approach is universally superior. Avoiding intraoperative opioids does not by itself establish greater safety (POFA trial). The block, not the opioid-free anesthetic, carries most of the evidence-supported analgesic benefit in breast surgery.
Sources and limits
- Dose sources: DOSING_SOURCES.md.
- Evidence base and certainty judgments: 06 — References & Evidence. Key sources:
- Foo et al. 2021, IV lidocaine consensus (doi:10.1111/anae.15270);
- Beloeil et al. 2021, POFA RCT (doi:10.1097/ALN.0000000000003725);
- Joshi et al. 2026, ASA local/regional analgesia guideline (doi:10.1097/ALN.0000000000005790).
- These sources do not validate an implant-revision-specific regimen. Check each source's population, comparator, follow-up and adverse effects before generalizing.