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Optimizing Pain Management in Plastic Surgery

This document discusses pain management strategies for plastic surgery. It notes that uncontrolled postoperative pain can lead to worse clinical outcomes and negative patient experiences. It emphasizes the importance of multimodal analgesia (MMA) approaches to optimize pain control and minimize narcotic use. MMA regimens combine local anesthetics, regional blocks, epidurals and other medications in a customized way for each patient and procedure. Plastic surgeons need to be knowledgeable about appropriate dosing and contraindications for all medications used in MMA.

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10 views1 page

Optimizing Pain Management in Plastic Surgery

This document discusses pain management strategies for plastic surgery. It notes that uncontrolled postoperative pain can lead to worse clinical outcomes and negative patient experiences. It emphasizes the importance of multimodal analgesia (MMA) approaches to optimize pain control and minimize narcotic use. MMA regimens combine local anesthetics, regional blocks, epidurals and other medications in a customized way for each patient and procedure. Plastic surgeons need to be knowledgeable about appropriate dosing and contraindications for all medications used in MMA.

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inge Ps
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
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Pain M anagement i n

Plastic Surgery
Anna R. Schoenbrunner, MD, MASa, Jeffrey E. Janis, MDb,*

KEYWORDS
 Pain management  Plastic surgery  Multimodal analgesia

KEY POINTS
 Poorly controlled postoperative pain is associated with worse clinical outcomes and negative pa-
tient experiences.
 Plastic surgeons must be well versed in multimodal analgesia (MMA) management strategies to
optimize postoperative pain control and minimize narcotic use.
 MMA regimens are customized to the patient and procedure.
 Local anesthetics, regional blocks, and epidurals are powerful adjuncts in any MMA regimen.
 Plastic surgeons must be aware of dosing and contraindications for all medications used as part of
an MMA regimen.

INTRODUCTION increased readmission rates, all of which may


affect reimbursement and patient satisfaction.6–11
Postoperative pain management in plastic sur- Uncontrolled postsurgical pain has also been
gery has become a topic of increasing interest. implicated in the development of persistent post-
Pain is the perceived sensory and emotional surgical pain (PPSP) caused by maladaptive
reaction to actual or perceived tissue injury.1 neuronal plasticity.12,13 PPSP is estimated to
Nociceptive pain is caused by suprathreshold affect 20% to 25% of mastectomy patients,
stimulation of peripheral pain receptors from 50% to 85% of amputation patients, and 5% to
damage to nonneural tissue.2 Inflammatory pain 35% of hernia repair patients.14,15
results from peripheral pain sensitization caused In the era of the American opioid epidemic, sur-
by activation of the immune system via chemical geons play a crucial role in optimizing postop-
mediators. Surgery causes tissue injury that erative pain and minimizing narcotic use.
leads to both nociceptive and inflammatory Nonpharmacologic pain management strategies
pain. Pathologic pain is caused by dysfunction such as mindfulness, massage, and acupuncture
of the nervous system without tissue damage; it have been found to be effective pain management
is maladaptive in that it serves no biological strategies and should be used.16 This article re-
function.3 views pain management strategies available to
Uncontrolled postsurgical pain has been asso- plastic surgeons based on therapeutic class of
ciated with increased risk of poor pulmonary medication and provides a framework for pain
function, myocardial ischemia, ileus, thromboem- management based on Enhanced Recovery After
bolism, and impaired immune function.4,5 It has Surgery (ERAS) protocols. Much of this content
been associated with increased postanesthesia
[Link]

was previously covered in a Plastic and Recon-


care unit stays, prolonged admissions, and structive Surgery Pain Management Supplement

a
Department of Plastic and Reconstructive Surgery, The Ohio State University, 915 Olentangy River Road,
Columbus, OH 43212, USA; b Department of Plastic and Reconstructive Surgery, Ohio State University Wexner
Medical Center, 915 Olentangy River Road, Columbus, OH 43212, USA
* Corresponding author.
E-mail address: [Link]@[Link]
Twitter: @aschoenbrunner (A.R.S.); @jjanismd (J.E.J.)

Clin Plastic Surg 47 (2020) 191–201


[Link]
0094-1298/20/Ó 2019 Elsevier Inc. All rights reserved.

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