Optimal Pain Control in Abdominal Wall Reconstruction

Khansa, Ibrahim; Jefferson, Ryan C.; Khansa, Lara; Janis, Jeffrey E.

doi:10.1097/prs.0000000000004870

Cited by 16 publications

(14 citation statements)

References 58 publications

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“…Gabapentin is often used as part of a patient- and procedure-specific multimodal analgesia regimen within enhanced recovery after surgery protocols, and has shown success in lowering the amount of oral morphine equivalents prescribed in the postoperative period. 17 Although gabapentin has generally been considered safe because of a decrease in opioid-related side effects, central nervous system depression (notably confusion, dizziness, and respiratory depression) remains a concern. 12,13 Hypotension is a documented, though less studied, side effect of gabapentin, and has been shown to coincide with gabapentin administration in animal models 18 and as a part of enhanced recovery after surgery protocols.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Adverse Effects of Multimodal Gabapentin in Abdominal Wall Reconstruction

Sarac

Schoenbrunner

Brower

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Multimodal analgesia, a key component of enhanced recovery after surgery protocols, emphasizes the use of nonopioid analgesics. Preoperative and postoperative gabapentin is often included within multimodal analgesia because it has been shown to reduce postoperative opioid use. However, the role of gabapentin has been questioned because of concerns of adverse effects, particularly in the elderly. In an effort to better understand the specific role of gabapentin within the context of an established enhanced recovery after surgery protocol, the authors studied the prevalence of its adverse effects in patients undergoing abdominal wall reconstruction. Methods: Following institutional review board approval, a retrospective review of a prospectively collected database of 267 consecutive patients who underwent abdominal wall reconstruction performed by a single surgeon was conducted. Demographic variables; operative details; postoperative analgesic use; the presence of dizziness, lightheadedness, or altered mental status; hypotension; negative Richmond Agitation Sedation Scale scores; and postoperative falls were recorded and analyzed according to postoperative gabapentin administration. Results: Two hundred thirteen patients (80 percent) met inclusion criteria, of which 138 (65 percent) received postoperative gabapentin. Postoperative gabapentin use was not associated with dizziness, lightheadedness, or altered mental status; hypotension; negative Richmond Agitation Sedation Scale scores; or falls. Furthermore, even among those aged 65 years or older, postoperative gabapentin use was not significantly associated with these adverse events. Conclusions: In patients undergoing abdominal wall reconstruction, postoperative gabapentin administration was not associated with an increase in adverse effects. Further prospective analysis may better allow the characterization of the adverse effects of perioperative gabapentin. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Section: Discussionmentioning

confidence: 99%

Analysis of Adverse Effects of Multimodal Gabapentin in Abdominal Wall Reconstruction

Sarac

Schoenbrunner

Brower

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…Opioid-free adjuncts, such as regional paravertebral anesthetic blocks, transverse abdominis plane blocks, and continuous wound infusion of local anesthetic agents, have shown benefit limiting systemic opioid use in microsurgical lower abdominal free flap breast reconstruction. [17][18][19][20][21][22][23][24][25] Objective metrics quantifying effectiveness of ERAS pathways in microsurgical breast reconstruction have largely been limited to perioperative narcotic use and postoperative length of stay. 18 Although limiting perioperative narcotic use has demonstrated clear short-term benefit for patients individually, 15,16 minimizing narcotic overprescription may have significant, but difficult to quantify, long-term societal benefits in the midst of the current opioid epidemic.…”

mentioning

confidence: 99%

Enhanced Recovery Pathway Reduces Hospital Stay and Opioid Use in Microsurgical Breast Reconstruction: A Single-Center, Private Practice Experience

Ochoa

Rajan

Garza

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: This study aimed to determine benefits of the Enhanced Recovery After Surgery (ERAS) pathway implementation in free flap breast reconstruction related to postoperative narcotic use and health care resource utilization. Methods: A retrospective analysis of consecutive patients undergoing deep inferior epigastric perforator flap breast reconstruction from November of 2015 to April of 2018 was performed before and after implementation of the ERAS protocol. Results: Four hundred nine patients met inclusion criteria. The pre-ERAS group comprised 205 patients, and 204 patients were managed through the ERAS pathway. Mean age, laterality, timing of reconstruction, and number of previous abdominal surgical procedures were similar (p > 0.05) between groups. Mean operative time between both groups (450.1 ± 92.7 minutes versus 440.7 ± 93.5 minutes) and complications were similar (p > 0.05). Mean intraoperative (58.9 ± 32.5 versus 31.7 ± 23.4) and postoperative (129.5 ± 80.1 versus 90 ± 93.9) morphine milligram equivalents used were significantly (p < 0.001) higher in the pre-ERAS group. Mean length of stay was significantly (p < 0.001) longer in the pre-ERAS group (4.5 ± 0.8 days versus 3.2 ± 0.6 days). Bivariate linear regression analysis demonstrated that operative time was positively associated with total narcotic requirements (p < 0.001) and length of stay (p < 0.001). Conclusions: ERAS pathways in microsurgical breast reconstruction promote reduction in intraoperative and postoperative narcotic utilization with concomitant decrease in hospital length of stay. In this study, patients managed through ERAS pathways required 46 percent less intraoperative and 31 percent less postoperative narcotics and had a 29 percent reduction in hospital length of stay.

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“…We have adapted the lessons learned from our own institutional experience to develop an MMA regimen to treat postsurgical pain in aesthetic plastic surgery patients. [124][125][126] Table 2 summarizes our recommendations for MMA options that can be customized based on the unique surgical procedure and patient characteristics. Table 3 provides alternative medication options for an MMA regimen.…”

Section: Putting It All Together: Mma Regimenmentioning

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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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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Optimal Pain Control in Abdominal Wall Reconstruction

Cited by 16 publications

References 58 publications

Analysis of Adverse Effects of Multimodal Gabapentin in Abdominal Wall Reconstruction

Analysis of Adverse Effects of Multimodal Gabapentin in Abdominal Wall Reconstruction

Enhanced Recovery Pathway Reduces Hospital Stay and Opioid Use in Microsurgical Breast Reconstruction: A Single-Center, Private Practice Experience

Multimodal Analgesia in the Aesthetic Plastic Surgery: Concepts and Strategies

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