Painless, Drainless Lipoabdominoplasty: A Retrospective Study of Pain Following Lipoabdominoplasty Utilizing Liposomal Bupivacaine and a Modified Enhanced Recovery After Surgery Protocol

Abstract

Background There are many functional and aesthetic benefits to lipoabdominoplasty (combination liposuction with abdominoplasty), including increase in core strength, reduction in urinary incontinence, and improvement in lower back pain. However, patients are still hesitant to undergo surgery due to the perceived fears of post-surgical drains, and post-operative pain. Objectives Propose a standardized multimodal pain protocol for patients undergoing lipoabdominoplasty procedures that aims to improve post-operative pain control. Methods A total of 80 patients operated on between July 2020 and December 2021 were evaluated in this study. Patients all underwent lipoabdominoplasty and were administered a standardized pre-, intra-, and post-operative pain regimen. Pain scores were measured across all patients in the immediate post-operative period, and post-operative days 1, 7, 28, and 90. Results Mean pain scores in the post-anesthesia recovery unit were 0.46/10 (+/- 0.18). Subsequent reassessment in the post-op recovery suite yielded mean pain scores of 0.34 (+/- 0.15). Mean pain scores on POD1 were 1.23 (+/- 0.15), and consistent through to postoperative day 7 (POD7) at 1.24 (+/- 0.11) with patients taking an average of 6.65 total Percocet 5mg during the week. After POD7, 95% (76/80) of patients were only taking nonsteroidal anti-inflammatory medications medications. A total of 75/80 patients (93.75%) reported zero pain at 4-6 weeks after surgery (mean pain score 0.10 +/- 0.08). Conclusions The multimodal analgesia protocol consisting of preoperative or immediate induction IV Tylenol, precut local analgesia with marcaine and lidocaine, and intraoperative use of liposomal bupivacaine, can improve perioperative pain control in patients undergoing lipoabdominoplasty.