Shauly Orr, Goel Pedram, Gould Daniel J
Department of Surgery, Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Department of Plastic Surgery, University of California, Irvine, Orange, CA, USA.
Aesthet Surg J Open Forum. 2022 May 26;4:ojac049. doi: 10.1093/asjof/ojac049. eCollection 2022.
There are many functional and aesthetic benefits to lipoabdominoplasty (combination of 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 postsurgical drains, and postoperative pain.
To propose a standardized multimodal pain protocol for patients undergoing lipoabdominoplasty procedures that aims to improve postoperative pain control.
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 preoperative, intraoperative, and postoperative pain regimen. Pain scores were measured across all patients in the immediate postoperative period, and postoperative days (PODs) 1, 7, 28, and 90.
Mean pain scores in the postanesthesia recovery unit were 0.46/10 (+/- 0.18). Subsequent reassessment in the postop 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 POD7 at 1.24 (+/- 0.11) with patients taking an average of 6.65 total Percocet 5 mg (Endo Pharmaceuticals Inc., Malvern, PA) during the week. After POD7, 95% (76/80) of patients were only taking nonsteroidal anti-inflammatory drugs. A total of 75/80 patients (93.75%) reported zero pain at 4 to 6 weeks after surgery (mean pain score 0.10 +/- 0.08).
The multimodal analgesia protocol consisting of preoperative or immediate induction intravenous Tylenol (Johnson & Johnson, New Brunswick, NJ), precut local analgesia with Marcaine (Pfizer Inc., New York, NY) and lidocaine, and intraoperative use of liposomal bupivacaine can improve perioperative pain control in patients undergoing lipoabdominoplasty.
腹壁成形术（抽脂术与腹壁成形术相结合）有许多功能和美学上的益处，包括增强核心力量、减少尿失禁以及改善下背部疼痛。然而，由于患者对术后引流管和术后疼痛的担忧，他们仍然对接受手术犹豫不决。
为接受腹壁成形术的患者提出一种标准化的多模式疼痛方案，旨在改善术后疼痛控制。
本研究评估了2020年7月至2021年12月期间接受手术的80例患者。所有患者均接受了腹壁成形术，并接受了标准化的术前、术中和术后疼痛治疗方案。在术后即刻以及术后第1、7、28和90天对所有患者进行疼痛评分。
麻醉后恢复室的平均疼痛评分为0.46/10（±0.18）。随后在术后恢复套房进行的重新评估得出平均疼痛评分为0.34（±0.15）。术后第1天的平均疼痛评分为1.23（±0.15），直到术后第7天一直保持在1.24（±0.11），患者在这一周内平均总共服用6.65片5毫克的羟考酮（Endo制药公司，宾夕法尼亚州马尔伯勒）。术后第7天后，95%（76/80）的患者仅服用非甾体抗炎药。共有75/80例患者（93.75%）在术后4至6周报告无痛（平均疼痛评分为0.10±0.08）。
由术前或即刻诱导静脉注射泰诺（强生公司，新泽西州新不伦瑞克）、用布比卡因（辉瑞公司，纽约）和利多卡因进行预切口局部镇痛以及术中使用脂质体布比卡因组成的多模式镇痛方案，可以改善接受腹壁成形术患者的围手术期疼痛控制。
