Basics and Best Practices of Multimodal Pain Management for the Plastic Surgeon

Barker, Jenny C.; Joshi, Girish P.; Janis, Jeffrey E.

doi:10.1097/gox.0000000000002833

Cited by 33 publications

(41 citation statements)

References 64 publications

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“…31 We recommend utilizing acetaminophen in all postoperative patients who do not have contraindications to its use as discussed above. 9,32,33 It should be scheduled around the clock in the first 72 hours after surgery. Plastic surgeons must exercise caution and educate their patients who take at home medications containing acetaminophen such as certain opioid combinations or cold medications.…”

Section: Acetaminophenmentioning

confidence: 99%

“…We recommend the use of gabapentin as an adjunctive multimodal medication for acute, postoperative pain only in patients who have a risk for nerve-related pain and in whom NSAIDs and COX-2 specific inhibitors are contraindicated. 32,33 In this patient population we advocate for gabapentin 600 mg orally the evening before surgery as well as 600 mg before the operation. In patients less than 65 years old, we favor 300 mg orally every 8 hours, whereas for patients more than 65 years, we favor twice daily dosing.…”

Section: Gabapentinoidsmentioning

confidence: 99%

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Multimodal Analgesia in the Aesthetic Plastic Surgery: Concepts and Strategies

Schoenbrunner

Joshi

Janis

2022

Plastic and Reconstructive Surgery - Global Open

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Background: Postoperative pain management is crucial for aesthetic plastic surgery procedures. Poorly controlled postoperative pain results in negative physiologic effects and can affect length of stay and patient satisfaction. In light of the growing opioid epidemic, plastic surgeons must be keenly familiar with opioid-sparing multimodal analgesia regimens to optimize postoperative pain control. Methods: A review study based on multimodal analgesia was conducted. Results: We present an overview of pain management strategies pertaining to aesthetic plastic surgery and offer a multimodal analgesia model for outpatient aesthetic surgery practices. Conclusion: This review article presents an evidence-based approach to multimodal pain management for aesthetic plastic surgery.

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Section: Acetaminophenmentioning

confidence: 99%

Section: Gabapentinoidsmentioning

confidence: 99%

Multimodal Analgesia in the Aesthetic Plastic Surgery: Concepts and Strategies

Schoenbrunner

Joshi

Janis

2022

Plastic and Reconstructive Surgery - Global Open

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“… 27 ERAS protocols and multimodal analgesia regimens are now becoming more widely used within the field of plastic surgery and can be tailored to specific operations and individual patient needs. 28 , 29 …”

Section: Discussionmentioning

confidence: 99%

Does An ERAS Protocol Reduce Postoperative Opiate Prescribing in Plastic Surgery?

et al. 2022

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Summary Background Enhanced recovery after surgery (ERAS) protocols are effective at reducing inpatient opiate use. There is a paucity of studies on the effects of an ERAS protocol on outpatient opiate prescriptions. The aim of this study was to determine whether an ERAS protocol for plastic and reconstructive surgery would reduce opiate use in the outpatient postoperative setting. Methods A statewide (Massachusetts, USA) controlled substance prescription monitoring database was retrospectively reviewed to assess the prescribing patterns of a single academic plastic surgeon performing common plastic surgical outpatient operations. The time period prior to implementation of the ERAS protocol was then compared with the time period following protocol implementation. An additional three months of post-implementation data were then compared with those of each of the previous time periods to investigate whether the results were sustained. Results A comparison of opiate prescriptions in pre-ERAS, immediate post-ERAS procedures, and follow-up ERAS implementation procedures revealed a statistically significant decrease in opiate prescriptions after ERAS protocol implementation. This decrease in the quantity of opiates prescribed was sustained over time . Conclusions ERAS protocols are effective at reducing outpatient opiate prescriptions after a variety of plastic surgery operations. Appropriate patient and physician education is paramount for success.

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“…Local injections of postoperative wounds, as part of postoperative pain management, have proven to be effective in some orthopaedic, neurosurgical, and cardiothoracic surgical procedures [15]. The benefits of the intra-articular and periarticular administration of bupivacaine are widely described, especially in relation to patients after alloplasties and procedures performed on the large joints of the lower limbs [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous Bupivacaine Infiltration Is Not Effective to Support Control of Postoperative Pain in Paediatric Patients Undergoing Spinal Surgery

Danielewicz

Fatyga²,

Starobrat³

et al. 2021

JCM

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Spinal deformity corrections in paediatric patients are long-lasting procedures involving damage to many tissues and long pain exposure; therefore, effective pain management after surgical treatment is an important issue. In this study, the effect of inclusion of local infiltration analgesia, as an integral part of the scheme in postoperative pain control, in children and adolescents, subjected to the spinal deformity correction procedure, was assessed. Thirty patients, aged 8 to 17 years, undergoing spinal deformity correction were divided into a study group, receiving a 0.25% bupivacaine solution before wound closure, and a control group (no local analgesic agent). Morphine, at the doses of 0.10 mg/kg of body weight, was administered to the patients when pain occurred. Pain scores, morphine administration, and bleeding were observed during 48 postoperative hours. The pain scores were slightly lower in a 0–4 h period in patients who received bupivacaine compared with those in the control group. However, no differences were observed in a longer period of time and in the total opioid consumption. Moreover, increasing bleeding was observed in the bupivacaine-treated patients (study group) vs. the control. Bupivacaine only modestly affects analgesia and, due to the increased bleeding observed, it should not to be part of pain control management in young patients after spinal deformity correction.

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Basics and Best Practices of Multimodal Pain Management for the Plastic Surgeon

Cited by 33 publications

References 64 publications

Multimodal Analgesia in the Aesthetic Plastic Surgery: Concepts and Strategies

Multimodal Analgesia in the Aesthetic Plastic Surgery: Concepts and Strategies

Does An ERAS Protocol Reduce Postoperative Opiate Prescribing in Plastic Surgery?

Subcutaneous Bupivacaine Infiltration Is Not Effective to Support Control of Postoperative Pain in Paediatric Patients Undergoing Spinal Surgery

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