American Association of Plastic Surgeons

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Less is More: Minimizing Narcotics Using a Multimodal Pain Regimen Improves Patient Reported Pain Scores
Brian Bassiri-Tehrani, MD, Itay Wiser, MD, Irena Karanetz, MD, Michael Marchese, MD, Oren Z. Lerman, MD.
Lenox Hill Hospital, New York, NY, USA.

Purpose:
Enhanced recovery after surgery (ERAS) is a paradigm for improving perioperative care by implementing a series of interventions that ultimately decreases hospital length of stay and lowers opioid consumption without any differences in complications. Because of this, specific interventions are now routinely performed perioperatively to achieve these goals; namely, multimodal pain management regimens are used. While narcotic consumption has traditionally been used to measure effective pain control, this study measures pain control by patient reported scales. Total narcotic consumption is not completely objective as patients metabolize narcotics differently, which may be contingent on preoperative dependency to narcotic use, or, genetic predisposition.
Methods:
One hundred and fifty-four patients underwent abdominal based autologous microsurgical breast reconstruction in which forty-nine patients had no Exparel injected into the abdominal fascia intraoperatively, and the remaining one-hundred and five patients had Exparel directly injected into the abdominal fascia. Pain scale measuring 1-10 (10=most pain) was used to measure pain in the recovery room immediately after surgery, and then every twelve hours thereafter until postoperative day three.
Results:
In a repeated measures test, there was a significant improvement of reported pain by patients in the group that received Exparel intraoperatively (p=0.001). In the group that didn't receive Exparel, the reported pain 95% CI=(3.079-4.157, mean=3.618, SD=0.272), whereas the group that did receive Exparel 95% CI=(2.111-2.869, mean=2.490, SD=0.191)
Conclusion:
Subjective pain reports by patients were significantly improved with multimodal pain control using intraoperative Exparel injection directly into the abdominal fascia in abdominal based autologous microsurgical breast reconstruction.


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