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Groff D, Freedman Z, Gilles A, Bone C, Johnson TS. Development of Opioid Use Disorder After Breast Reconstruction: Effects of Nicotine Exposure. Ann Plast Surg 2024; 92:S241-S244. [PMID: 38556681 DOI: 10.1097/sap.0000000000003793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION After undergoing breast reconstructive surgery, patients are typically prescribed opioids. Smoking tobacco increases rate of opioid metabolism and is associated with development of opioid use disorder (OUD). The aim of this study was to determine whether patients who smoke have an increased risk of OUD after breast reconstructive surgery. Given that OUD is a known risk factor for injection drug use and intravenous drug use increases risk of acquiring blood-borne diseases including human immunodeficiency virus (HIV) and hepatitis, the secondary aim was to determine if these patients are also at increased risk of acquiring these communicable diseases associated with OUD. METHODS A retrospective analysis was conducted using TriNetX, a multi-institutional deidentified database. Individuals included underwent a breast reconstructive surgery and received postoperative opioid treatment. The exposed group included patients who smoke. The control group did not smoke. Risk of developing OUD, hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV from 12 to 36 months after surgery was compared between groups. Patients with preexisting OUD or associated diseases were excluded. Cohorts were matched to control for confounding factors including age, sex, race, mental health history, and concomitant substance use. RESULTS There were 8648 patients included in the analysis. After matching, 4324 patients comprised the exposure group, and 4324 patients remained in the control group. Preoperative smoking was significantly associated with increased risk of OUD at 12, 24, and 36 months after breast reconstruction (36 months: odds ratio [OR], 2.722; confidence interval [CI], 2.268-6.375). Smoking was also associated with increased risk of HIV and HCV at all time points after surgery (36 months HIV: OR, 2.614; CI, 1.977-3.458; 36 months HCV: OR, 3.718; CI, 2.268-6.375) and increased risk of HBV beginning at 24 months after surgery (36 months HBV: OR, 2.722; CI, 1.502-4.935). CONCLUSIONS Individuals who smoke have an increased risk of developing OUD, HIV, HCV, and HBV after breast reconstructive surgery. This risk persists for at least 3 years after surgery. Additional research and clinical interventions focusing on early identification of OUD, prevention efforts, and harm reduction strategies for patients who smoke or have nicotine dependence undergoing breast reconstruction are warranted.
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Affiliation(s)
| | | | - Ambroise Gilles
- Division of Plastic and Reconstructive Surgery, Pennsylvania State Hershey Medical Center, Hershey, PA
| | | | - Timothy Shane Johnson
- Division of Plastic and Reconstructive Surgery, Pennsylvania State Hershey Medical Center, Hershey, PA
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Oñate Valdivieso C, Oñate Valdivieso D, Hoyos AE, Perez Pachon ME, Aguilar Villa H, Michels PJA, Viera A, Benavides JE, Villabona SJ, Ramirez B. Ultrasonic- and Ultrasound-assisted Improvement of Silhouette of the Torso: Bone Structure High-definition Remodeling (Part I). PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5513. [PMID: 38204869 PMCID: PMC10781136 DOI: 10.1097/gox.0000000000005513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/08/2023] [Indexed: 01/12/2024]
Abstract
Background High-definition liposculpture allowed plastic surgeons to achieve better aesthetic results by carving the underlying muscles and contours in a new way. Several authors have improved the original technique by adding other procedures and new technologies. We designed a new improvement by incorporating bone transformation surgery to overcome the lack of silhouette at the waist and, as a result, optimize the breast-waist-hip ratios. Methods We carried out a prospective multicenter study, with five different surgeons performing the same rib remodeling technique for waist definition. We used an ultrasonic piece for costal corticotomy and real-time ultrasound imaging to perform green-stick fractures over the last two or three floating ribs. Ours is a new technique based on the prior one described by Kudzaev. Results We reported 131 consecutive patients who were enrolled in this study. Waistline diameter decreased an average of 8 cm after surgery (P < 0.05). Most patients were women (n = 125, 95.4%). No major complications were reported. Most common complication was prolonged pain, with only three cases of contour asymmetry, all of which were attributable to noncompliance of constantly wearing the corset + compressive garments. Patients reported a high satisfaction rate and fast recovery (Body-QoL survey). Conclusions Ultrasonic- and ultrasound- assisted indentation surgery of the thorax is a safe and reliable technique for waistline definition, with a high satisfaction rate, almost-invisible scars, and minimal risk for complications. Incorporation of high-definition liposculpture to rib remodeling opens up a new horizon for bone structure modification surgery (S-high-definition remodeling) that can be safely performed for patients who seek better aesthetic outcomes in body contouring.
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Affiliation(s)
| | | | | | - Mauricio E. Perez Pachon
- Departments of Sciences and Research and Plastic Surgery, Total Definer, Bogota, Colombia
- Department of Surgery, Mayo Clinic; Rochester, Minn
| | | | | | - Andres Viera
- Department of Plastic Surgery at Total Definer, Private Practice, Moscow, Russia
| | - Jorge E. Benavides
- Total Definer Medical, Bogota, Colombia
- Private Practice, Bogota and Medellin, Colombia
| | - Silvia J. Villabona
- Department of Plastic Surgery at HAV, Clinica Fundacion Oftalmologica de Santander (FOSCAL), Bucaramanga, Colombia
| | - Brian Ramirez
- Department of Epidemiology, Total Definer Medical, Bogota, Colombia
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Winter J, Cruise B, Peters BR, Islur A. Pain Medication Prescribing Patterns in Augmentation Mammoplasty. Plast Surg (Oakv) 2023; 31:270-274. [PMID: 37654542 PMCID: PMC10467444 DOI: 10.1177/22925503211034828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/22/2021] [Indexed: 09/02/2023] Open
Abstract
Background The rate of opioid prescribing after low-risk surgical procedures has increased over the past decade, and surgeons are responsible for prescribing approximately one-third of all opioid medications. There is additional supporting evidence that patients only consume about half of the opioids prescribed to them after outpatient plastic surgery. Currently, there is no literature to provide surgeons with reference ranges for how much opioid medication will adequately provide analgesia for patients after undergoing bilateral breast augmentation (BBA) surgery. Objective To quantify the amount of opioid medication required to adequately control pain for patients after undergoing BBA and use these data to provide recommendations on opioid prescribing practices. Methods Cross-sectional prospective data were obtained through a take-home medication and pain tracking questionnaire for 56 patients after they underwent either subpectoral or subglandular BBA. Patients documented their pain scores on a 0 to 10 analogue scale and documented the type and amount of pain medication they took for a 7-day period. Results Our study demonstrated that patients in the subglandular BBA group required an average of either 25 ± 1.2 Tylenol #3 or 19.3 ± 2.3 Tramacet tablets, and the subpectoral group required 27.7 ± 1.7 Tylenol #3 or 25.6 ± 0.9 Tramacet tablets over a 7-day period. There was no statistically significant difference between the 2 surgical groups. Conclusion We propose a reference range of medication required on average for patients undergoing BBA to obtain adequate pain control in the initial postoperative period that falls within the most recent Canadian guidelines for safe opioid prescribing practices.
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Affiliation(s)
- Jessica Winter
- Section of Plastic Surgery, Department of Surgery, Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Braden Cruise
- Undergraduate Medical Education, Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Blair R. Peters
- Section of Plastic Surgery, Department of Surgery, Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Avi Islur
- Section of Plastic Surgery, Department of Surgery, Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- First Gland Cosmetic Clinic, Manitoba, Winnipeg, Manitoba, Canada
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Meade PJ, Matzko CN, Stamm MA, Mulcahey MK. Females Are More Likely Than Males to Fill an Opioid Prescription in the Year After Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2023; 5:100758. [PMID: 37645396 PMCID: PMC10461209 DOI: 10.1016/j.asmr.2023.100758] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 05/25/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose To report rates of preoperative and postoperative opioid use between male and female patients and to identify risk factors for extended opioid use following anterior cruciate ligament reconstruction (ACLR). Methods Patients undergoing ACLR between 2011 and 2018 were identified from the PearlDiver database. The opioid refill rates for males vs females were compared at monthly intervals for 1 year after ACLR. Patients who filled an opioid prescription <3 months before surgery were classified as opioid users, while those who had never filled one were classified as nonopioid users. Results Of 106,995 ACLR patients, 37,890 (35.4%) were opioid users <3 months before surgery, and 37,554 (35.1%) had never filled an opioid prescription. Of the preoperative opioid users, 20,413 (53.9%) were female and 17,477 (46.1%) were male (P < .001). Postoperatively, females were at higher risk of filling an opioid prescription at each monthly interval, except for the first month after surgery. The refill rate for opioid users was also higher than that for nonopioid users at each monthly interval after ACLR. In addition to patient sex, a preoperative diagnosis of anxiety/depression, low back pain, myalgia, a history of drug dependence, alcohol abuse, and tobacco use increased a patient's risk of filling an opioid prescription postoperatively. Conclusions This study demonstrated that females are significantly more likely to be opioid users than males prior to ACLR and are more likely to continue to refill an opioid prescription in the year following surgery. Multiple risk factors were associated with prolonged postoperative opioid utilization, including female sex, anxiety/depression, low back pain, myalgia, a history of drug dependence, alcohol abuse, and tobacco use. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Patrick J. Meade
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | | | - Michaela A. Stamm
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Mary K. Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
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Multimodal Pain Control Reduces Narcotic Use after Outpatient Abdominoplasty: Retrospective Analysis in an Ambulatory Surgery Practice. Plast Reconstr Surg Glob Open 2023; 11:e4777. [PMID: 36699223 PMCID: PMC9870214 DOI: 10.1097/gox.0000000000004777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/28/2022] [Indexed: 01/27/2023]
Abstract
Despite dominating fewer headlines, the opioid epidemic continues to plague society. Surgeons have the responsibility to change their opioid prescribing habits while maintaining adequate patient comfort. This study examines the transition to a multimodal, perioperative protocol in an ambulatory surgery setting for abdominoplasty patients. We hypothesized that using multimodal analgesia could significantly reduce narcotic consumption. Methods The authors retrospectively compared one surgeon's consecutive abdominoplasty patients over 24 months. The control group received primarily narcotic medications to manage pain, and the treatment cohort was given a multimodal protocol for perioperative analgesia. Results Demographic data, surgical time, and postanesthesia care unit time between the groups were similar. Although the mean intravenous narcotic decreased in the operating room and postanesthesia care unit for the treatment group, it failed to achieve statistical significance. The treatment cohort was prescribed two-thirds less oral narcotic than the control (251 versus 787 mean morphine milligram equivalents P < 0.001). Ten patients in the treatment cohort used no oral narcotics compared to one in the control (P = 0.002), and only four narcotic refills were given in the treatment group compared to 36 in the control (P < 0.001), suggesting that the treatment group had better pain control despite taking fewer narcotics. Conclusions Optimally utilizing multimodal medications effectively reduces narcotic consumption while effectively managing postoperative pain from abdominoplasty in a private practice, ambulatory surgery setting. Surgeons must change their prescribing habits if we are going to make progress in the war against the opioid crisis.
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Deptula P, Zak Y, Dua M, Wapnir I, Nguyen D. Minimizing Postoperative Pain in Autologous Breast Reconstruction With the Omental Fat-Augmented Free Flap. Ann Plast Surg 2022; 88:S374-S378. [PMID: 35180753 DOI: 10.1097/sap.0000000000003084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The omental fat-augmented free flap (O-FAFF) is a recently developed technique for autologous breast reconstruction. Our aim of the study is to evaluate the outcomes of our early case series. We assess the O-FAFF donor site morbidity in terms of postoperative pain, narcotic, and antiemetic use. METHODS A retrospective analysis of patients undergoing O-FAFF from 2019 to 2021 was performed. Patients were evaluated for demographic data, operative time, hospital course, and complications. Mean pain scores (1-10 scale) and narcotic pain medication use in oral morphine equivalents and doses of antiemetic medications during their hospital course were analyzed. We compared outcomes of our O-FAFF group with those of a control group of patients who underwent breast reconstruction with traditional free abdominal tissue transfer. RESULTS A total of 14 patients underwent O-FAFF breast reconstruction, representing 23 breasts. Patients had an average age of 48.5 years (±2.3 years) and body mass index of 22.6 kg/m 2 (±1.09 kg/m 2 ). Average follow-up was 232 days (±51 days). Average mastectomy weight was 245.6 g (±30.2 g) and average O-FAFF weight was 271 g (±31.7 g). Average pain scores on postoperative day 1 (POD1), POD2, and POD3 were 3.1 (±0.28), 2.8 (±0.21), and 2.1 (±0.35), respectively. The average narcotic use by patients in oral morphine equivalents on POD1, POD2, and POD3 are 24.3 (±5.5), 21.9 (±4.6), and 6.2 (±2.4), respectively. Total narcotic use during hospital stay was 79.4 mg (±11.1 mg). Average pain scores and narcotic use are significantly lower when compared with a previously published cohort of patients who underwent autologous breast reconstruction with free abdominal tissue transfer ( P < 0.05). Average antiemetic use was lower in the O-FAFF group compared with the control group: 3.5 versus 4.8 doses ( P = 0.6). Hospital length of stay was 3.0 days (±0.0 days). No complications were noted (0%). Patients were universally satisfied with their reconstructive outcome (100%). CONCLUSIONS The O-FAFF is proven to be a viable method of autologous breast reconstruction. Early series of patients undergoing O-FAFF reconstruction suggest a lower donor site morbidity as demonstrated by lower postoperative pain scores and lower consumptions of narcotic pain medications.
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Affiliation(s)
- Peter Deptula
- From the Department of Surgery, Stanford University Medical Center, Stanford, CA
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Long E, Maselli A, Barron S, Morgenstern M, Comer CD, Chow K, Cauley R, Lee B. Applications of Ultrasound in the Postoperative Period: A Review. J Reconstr Microsurg 2022; 38:245-253. [DOI: 10.1055/s-0041-1740959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background Recent advances in ultrasound technology have further increased its potential for routine use by plastic and reconstructive surgeons.
Methods An extensive literature review was performed to determine the most common applications of ultrasound in the postoperative care of plastic and reconstructive surgery patients.
Results In contrast with other available imaging modalities, ultrasound is cost-effective, rapid to obtain, eliminates the need for ionizing radiation or intravenous contrast, and has virtually no contraindications. In addition to its diagnostic capabilities, ultrasound can also be used to facilitate treatment of common postoperative concerns conveniently at the bedside or in an office setting.
Conclusion This article presents a review of the current applications of ultrasound imaging in the postoperative care of plastic and reconstructive surgery patients, including free flap monitoring following microsurgery, diagnosis and treatment of hematoma and seroma, including those associated with BIA-ALCL, and breast implant surveillance.
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Affiliation(s)
- Emily Long
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Amy Maselli
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sivana Barron
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Monica Morgenstern
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Carly D. Comer
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kaimana Chow
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ryan Cauley
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Bernard Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Analysis of Adverse Effects of Multimodal Gabapentin in Abdominal Wall Reconstruction. Plast Reconstr Surg 2022; 149:733-739. [PMID: 35041638 DOI: 10.1097/prs.0000000000008836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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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Sharif-Askary B, Abdou SA, Singh T, Song DH. Are US Plastic Surgery Residents Equipped to Face the Opioid Epidemic? A National Survey. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3761. [PMID: 34476156 PMCID: PMC8382490 DOI: 10.1097/gox.0000000000003761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
The United States opioid epidemic is among this century’s most profound threats to public health and demands that all physicians consider their role in reversing its trajectory. Previous literature demonstrated that plastic surgery trainees lack vital practices that promote opioid stewardship. However, it is not understood why this practice gap exists. This is a national survey-based study evaluating the availability and effectiveness of opioid education in US plastic surgery programs. A total of 91 residents completed the survey. Our study found that there is an unmet need for practical and comprehensive training regarding safe opioid prescribing among plastic surgery trainees. “Informal training,” defined as the “learn as you go” method, was found to be more common than formal training and considerably more valuable according to trainees. Trainees cited real-world applicability of informal training and that it comes from teachers whom they know and trust as valuable attributes of this type of education. Furthermore, the severity of the opioid epidemic has not translated into improved trainee education, as there was no significant difference in knowledge on safe opioid prescribing practices between junior and senior residents. To change the course of the epidemic, plastic surgery programs need to better train younger generations who believe they are critical stakeholders. This study lays the framework for the “formalization of informal training,” and the creation of practical and efficacious educational initiatives.
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Affiliation(s)
- Banafsheh Sharif-Askary
- MedStar Georgetown University Hospital Department of Plastic and Reconstructive Surgery, Washington, D.C
| | - Salma A Abdou
- MedStar Georgetown University Hospital Department of Plastic and Reconstructive Surgery, Washington, D.C
| | - Tanvee Singh
- MedStar Georgetown University Hospital Department of Plastic and Reconstructive Surgery, Washington, D.C
| | - David H Song
- MedStar Georgetown University Hospital Department of Plastic and Reconstructive Surgery, Washington, D.C
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An Analgesic Regimen for Opioid Reduction in Elective Plastic Surgery: A Randomized Prospective Study. Plast Reconstr Surg 2021; 147:325e-330e. [PMID: 33565839 DOI: 10.1097/prs.0000000000007592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Prescription opioid misuse has been recognized as a national epidemic. The implications of this problem are especially important to consider, as postoperative opioid abuse can give rise to true addiction for surgical patients. The concept of enhanced recovery after surgery is increasingly used across various specialties to decrease the overabundance of postoperative opioid use. METHODS This study prospectively examined 143 patients undergoing cosmetic elective surgery. Patients were randomized into one of two groups based on postoperative pain management regimen: multimodal (enhanced recovery after surgery) analgesia or traditional opioid analgesia. Data regarding postoperative pain scores, amount of postoperative opioids consumed, and duration of postoperative pain pill use were analyzed. RESULTS Multimodal (enhanced recovery after surgery) regimen patients experienced a 13.0 percent reduction in their pain scores after admission to the postanesthesia care unit and a 34.2 percent reduction in pain score at discharge, compared with traditional opioid patients (p = 0.049 and p = 0.0036, respectively). Enhanced recovery after surgery patients experienced a 35 percent reduction in the number of pills taken in the postoperative period and an 18.4 percent reduction in the duration of consumption (p = 0.0007 and p = 0.0539, respectively). CONCLUSIONS The results demonstrate that multimodal postoperative pain management is an important tool for decreasing the amount of opioids prescribed and needed in the postoperative period. The overprescribing of opioids after surgery is a precursor to abuse and the increase in the national opioid reservoir. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Rappaport NH. Commentary on: Enhanced Recovery After Surgery Protocol With Ultrasound-Guided Regional Blocks in Outpatient Plastic Surgery Patients Leads to Decreased Opioid Prescriptions and Consumption. Aesthet Surg J 2021; 41:NP1115-NP1117. [PMID: 33837747 DOI: 10.1093/asj/sjab184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Berg J, Wahood W, Zreik J, Yolcu YU, Alvi MA, Jeffery M, Bydon M. Economic Burden of Hospitalizations Associated with Opioid Dependence Among Patients Undergoing Spinal Fusion. World Neurosurg 2021; 151:e738-e746. [PMID: 34243673 DOI: 10.1016/j.wneu.2021.04.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/23/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The current study seeks to examine the association between chronic opioid use and postoperative outcomes for patients undergoing anterior cervical discectomy and fusion (ACDF) and posterior lumbar fusion (PLF). METHODS The National Inpatient Sample was queried for patients with and without chronic opioid use undergoing ACDF or PLF for degenerative disc disease between 2012 and 2015 using ICD-9 diagnosis and procedure codes. Multivariable conditional logistic regression was performed to assess the association between chronic opioid use and length of stay (LOS), nonhome discharge, and hospital charge. RESULTS A total of 391 patients undergoing ACDF and 644 patients undergoing PLF with opioid dependence were identified. On multivariable regression analysis, opioid dependence was significantly associated with an increased LOS (mean, 3.09 days vs. 2.16 days; odds ratio (OR) for prolonged LOS (>3 days), 2.11; 95% confidence interval [CI], 1.43-3.14; P < 0.001). Although on unadjusted analyses, patients with opioid dependence undergoing ACDF were found to have higher hospital charges (mean, U.S. $18,698.42 vs. $11,378.61; P < 0.001) and higher rates of nonroutine discharge (19.18% vs. 10.21%; P < 0.001), the multivariable regression analyses found no significant association between opioid dependence and odds of hospital charges >75th percentile (OR, 1.44; 95% CI, 0.84-2.47; P = 0.188) or nonroutine discharge (OR, 1.48; 95% CI, 0.93-2.34; P = 0.098). For those undergoing PLF, opioid dependence was significantly associated with increased hospital charges (mean, U.S. $37,712.98 vs. $30,475.43, P < 0.001; OR for hospital charge >75th percentile, 1.78, 95% CL, 1.23-2.58, P = 0.002), LOS (mean, 3.42 days vs. 2.30 days; OR for prolonged LOS, 1.53; 95% CI, 1.16-2.00; P = 0.003), and nonroutine discharge (46.89% vs. 36.47%; OR, 1.74; 95% CI, 1.34-2.26; P < 0.001) on both unadjusted and adjusted multivariable regression analyses. CONCLUSIONS Our analysis using a national administrative database showed that opioid dependence may be associated with worse economic outcomes for patients undergoing ACDF and PLF.
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Affiliation(s)
- Jake Berg
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; University of Notre Dame, Notre Dame, Indiana, USA
| | - Waseem Wahood
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida, USA
| | - Jad Zreik
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA
| | - Yagiz U Yolcu
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammed Ali Alvi
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Molly Jeffery
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Cardwell TW, Zabala V, Mineo J, Ochner CN. The Effects of Perioperative Peripheral Nerve Blocks on Peri- and Postoperative Opioid Use and Pain Management. Am Surg 2021; 88:2842-2850. [PMID: 34162251 DOI: 10.1177/00031348211023395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The amount of peri- and post-operative use of opioids for pain management, and the duration in which they are used following surgery, are positively associated with the likelihood of subsequent opioid use and addiction. Aware of this issue, many clinicians are seeking ways to reduce opioid use while maintaining adequate pain management. Recent evidence suggests that peripheral nerve block utilization may present a viable mechanism by which clinicians can accomplish this goal. METHODS Ovid MEDLINE and Pubmed databases were searched to identify relevant articles. Using the advanced search option, the key terms "opioid," "morphine," "nerve block," "peripheral anesthesia," "pain management," "preoperative,", "intraoperative," and "postoperative" were used and combined with the Boolean terms "AND" and "OR." This review examines the extant literature surrounding the use of peripheral nerve blocks in relation to patient-reported pain scores, intraoperative opioids, postoperative opioids, patient-controlled analgesic with opioids, and opioid consumption once the patient has left the hospital. Further, the effect peripheral nerve blocks have on postoperative physical therapy, surgery related complications, and overall patient satisfaction are briefly discussed. RESULTS The use of perioperative peripheral nerve blocks decreases opioid consumption not only in the postoperative period, but also intraoperatively as well. The most significant decrease in opioid consumption is seen in the first 24-72 hours postoperatively. Patient reported pain scores were also lower in patients who received peripheral nerve blocks. DISCUSSION Despite relatively robust efficacy data, utilization of peripheral nerve blocks is not ubiquitous; the potential reasons for which are also discussed. Lastly, clinical recommendations based on the available data are provided.
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Affiliation(s)
- Taylor W Cardwell
- 23686Aventura Hospital and Medical Center, Aventura, FL,USA.,136414St George's School of Medicine, St George's, Grenada
| | - Vanessa Zabala
- 136414St George's School of Medicine, St George's, Grenada
| | - Jocelyn Mineo
- 2757Hospital Corporation of America, Nashville, TN, USA
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14
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Practical Review of Abdominal and Breast Regional Analgesia for Plastic Surgeons: Evidence and Techniques. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3224. [PMID: 33425573 PMCID: PMC7787285 DOI: 10.1097/gox.0000000000003224] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/08/2020] [Indexed: 12/15/2022]
Abstract
Regional analgesia has been increasing in popularity due to its opioid- sparing analgesic effects and utility in multimodal analgesia strategies. Several regional techniques have been used in plastic surgery; however, there is a lack of consensus on the indications and the comparative efficacy of these blocks. The goal of this review is to provide evidence-based recommendations on the most relevant types of interfascial plane blocks for abdominal and breast surgery. A systematic search of the PUBMED, EMBASE, and Cochrane databases was performed to identify the evidence associated with the different interfascial plane blocks used in plastic surgery. The search included all studies from inception to March 2020. A total of 126 studies were included and used in the synthesis of the information presented in this review. There is strong evidence for using the transversus abdominis plane blocks in both abdominoplasties as well as abdominally-based microvascular breast reconstruction as evidenced by a significant reduction in post-operative pain and opioid consumption. Pectoralis (I and II), serratus anterior, and erector spinae plane blocks all provide good pain control in breast surgeries. Finally, the serratus anterior plane block can be used as primary block or an adjunct to the pectoralis blocks for a wider analgesia coverage of the breast. All the reviewed blocks are safe and easy to administer. Interfascial plane blocks are effective and safe modalities used to reduce pain and opioid consumption after abdominal and breast plastic surgery.
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15
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Krajina Kmoniček I, Kvolik S, Pinotić K, Ištvanić T, Mraovic B, Marjanovic K. Epidural analgesia for acute ischemic pain after intra-arterial zolpidem injection in opioid-addicted patient-A case report. Clin Case Rep 2020; 8:3445-3449. [PMID: 33363949 PMCID: PMC7752646 DOI: 10.1002/ccr3.3445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 08/13/2020] [Accepted: 10/07/2020] [Indexed: 01/08/2023] Open
Abstract
A patient taking opioid maintenance therapy unintentionally injected dissolved zolpidem pills into the femoral artery and suffered acute limb ischemia. High amounts of opioids with supplemental therapies were inefficient for intractable ischemic pain, suggesting the presence of opioid-induced hyperalgesia (OIH). Epidural analgesia efficiently relieved pain and symptoms of OIH.
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Affiliation(s)
| | - Slavica Kvolik
- Department of AnesthesiologyOsijek University HospitalOsijekCroatia
- Faculty of MedicineJosip Juraj Strossmayer University of OsijekOsijekCroatia
| | - Kresimir Pinotić
- Faculty of MedicineJosip Juraj Strossmayer University of OsijekOsijekCroatia
- Department of SurgeryOsijek University HospitalOsijekCroatia
| | - Tomislav Ištvanić
- Faculty of MedicineJosip Juraj Strossmayer University of OsijekOsijekCroatia
- Department of SurgeryOsijek University HospitalOsijekCroatia
| | - Boris Mraovic
- Department of Anesthesiology & Perioperative MedicineSchool of MedicineUniversity of MissouriColumbiaMOUSA
| | - Ksenija Marjanovic
- Faculty of MedicineJosip Juraj Strossmayer University of OsijekOsijekCroatia
- Department of PathologyOsijek University HospitalOsijekCroatia
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16
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Abstract
An interdisciplinary pain team was established at our institution to explore options for improving pain control in patients undergoing orthopedic surgery by identifying traits that put a patient at increased risk for inadequate pain control postoperatively.
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17
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Our Collective Responsibility in Battling the Opioid Crisis. Plast Reconstr Surg 2020; 146:713-715. [PMID: 32842122 DOI: 10.1097/prs.0000000000007082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Decreasing Opioid Prescriptions in Women Undergoing Mastectomy and Breast Reconstruction. Pain Manag Nurs 2020; 21:339-344. [PMID: 32280011 DOI: 10.1016/j.pmn.2020.02.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/12/2020] [Accepted: 02/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Florida enacted legislation limiting opioid prescriptions and affecting the management of acute pain in the postoperative patient. Patients in a reconstructive surgery practice were receiving prescriptions for opioids as their primary method of pain management. Clinic providers identified a need to limit opioid prescriptions. AIM The aim of this quality improvement initiative was to decrease the number of opioids prescribed while effectively managing pain in women undergoing mastectomy and breast tissue expander placement. DESIGN This is a quality improvement project. METHODS The Model for Improvement was used as a framework for this project. An evidence-based pain management plan was developed after a review of the breast reconstruction surgery literature. The plan incorporated preoperative patient and family education and the standard use of preemptive analgesia, intraoperative nerve blocks, and postoperative multimodal analgesia in all patients undergoing mastectomy with breast tissue expander placement. Patient and family education and perioperative pain management were provided to patients, and the number of opioid tablets prescribed was tracked. RESULTS Between January 2018 and August 2019, the average number of opioid tablets prescribed per patient decreased from 84.7 to 8.4. CONCLUSIONS Opioid prescriptions can be decreased in women undergoing breast reconstruction with the use of patient education and multimodal analgesia.
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Siotos C, Cheah MA, Karahalios A, Seal SM, Manahan MA, Rosson GD. Interventions for reducing the use of opioids in breast reconstruction. Hippokratia 2020. [DOI: 10.1002/14651858.cd013568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Charalampos Siotos
- Rush University Medical Center; Department of Surgery, Division of Plastic and Reconstructive Surgery; Chicago IL USA
| | - Michael A Cheah
- Johns Hopkins University School of Medicine; Department of Plastic and Reconstructive Surgery; 601 N. Caroline Street Baltimore MD USA 21287
| | - Amalia Karahalios
- Monash University; School of Public Health and Preventive Medicine; Melbourne Australia
| | - Stella M Seal
- Johns Hopkins University School of Medicine; Welch Medical Library; 2024 E. Monument St. Baltimore MD USA 21287
| | - Michele A Manahan
- Johns Hopkins University School of Medicine; Department of Plastic and Reconstructive Surgery; 601 N. Caroline Street Baltimore MD USA 21287
| | - Gedge D Rosson
- Johns Hopkins University School of Medicine; Department of Plastic and Reconstructive Surgery; 601 N. Caroline Street Baltimore MD USA 21287
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20
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Joseph WJ, Cuccolo NG, Chow I, Moroni EA, Beers EH. Opioid-Prescribing Practices in Plastic Surgery: A Juxtaposition of Attendings and Trainees. Aesthetic Plast Surg 2020; 44:595-603. [PMID: 31907588 DOI: 10.1007/s00266-019-01588-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/10/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The rates of opioid abuse and overdose in America have risen in parallel with the rates of opioid prescribing by physicians. As such, we sought to examine the prescribing practices among plastic surgery attendings and trainees to determine the need for more thorough education. METHODS A survey was distributed to all ACGME-accredited plastic surgery residency programs and included questions regarding opioid-prescribing practices and self-rated ability pertaining to opioid management. Trends in prescribing practices based on prescriber position were analyzed using cumulative odds ordinal logistic regression with proportional odds and Chi-squared tests for ordinal and nominal variables, respectively. RESULTS We received 78 responses with a wide geographical representation from plastic surgery residency programs: 59% of respondents were male and 39.7% female, 29.5% were attendings, 26.9% senior residents, 29.5% junior residents, and 14.1% interns. Compared with attendings, interns prescribe fewer pills (p < 0.05) and were significantly more likely to prescribe oxycodone (p < 0.03). Junior residents were 4.49 times more likely (p = 0.012) and senior residents 3.65 times more likely (p = 0.029) to prescribe additional opioids to avoid phone calls and follow-up visits. Interns and senior residents were significantly less comfortable than attendings in managing patients requesting additional opioids (p < 0.02). CONCLUSIONS The results of this survey demonstrate that knowledge deficits do exist among trainees, and that trainees are significantly less comfortable than their attending counterparts with opioid prescribing and patient management. Therefore, the implementation of a thorough postoperative pain management education in residency may be a cogent strategy in mitigating the opioid crisis. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Walter J Joseph
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, 3550 Terrace Street, Scaife Hall, Suite 6B, Pittsburgh, PA, 15261, USA.
| | - Nicholas G Cuccolo
- Division of Plastic Surgery, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ian Chow
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, 3550 Terrace Street, Scaife Hall, Suite 6B, Pittsburgh, PA, 15261, USA
| | - Elizabeth A Moroni
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, 3550 Terrace Street, Scaife Hall, Suite 6B, Pittsburgh, PA, 15261, USA
| | - Emily H Beers
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, 3550 Terrace Street, Scaife Hall, Suite 6B, Pittsburgh, PA, 15261, USA
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21
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Paasch C, Fiebelkorn J, Berndt N, De Santo G, Aljedani N, Ortiz P, Gauger U, Boettge K, Anders S, Full H, Strik MW. The transversus abdominis plane block reduces the cumulative need of analgesic medication following inguinal hernia repair in TAPP technique: a retrospective single center analysis among 838 patients. Hernia 2020; 24:1371-1378. [PMID: 32170456 DOI: 10.1007/s10029-020-02156-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 02/19/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Laparoscopic inguinal hernia repair (IHR) may lead to early postoperative pain. Therefore, opioid and non-opioid analgesic agents are often administered in the post-anesthesia care unit (PACU). To reduce the postoperative cumulative need of analgesic medication, as well as to accelerate the physical recovery time, the transversus abdominis plane (TAP) block has recently been studied. The TAP block is a regional anesthesia technique. Even though there is evidence about the efficacy of the block used in procedure such as an open inguinal hernia repair, the evidence regarding its use for the TAPP (transabdominal preperitoneal) technique remains low. We aim to provide more sufficient evidence regarding this topic. METHODS A monocentric retrospective observational study investigating the effect of the TAP block prior to primary IHR in TAPP technique was conducted. The data of 838 patients who were operated on using this technique from June 2007 to February 2019 were observed. 72 patients were excluded because of insufficient information regarding their analgesic medication protocol. The patients' data were taken from their files. RESULTS The patients in the TAP block group (n = 364) did not differ statistically significantly compared to the control group (n = 402) in terms of gender, BMI and age. Individuals of the TAP block group experienced less postoperative pain in the PACU (p < 0.001) and received less analgesic medication (morphine, oxycodone, piritramide, acetaminophen; p < 0.001). CONCLUSION We assume that the TAP block is a sufficient approach to reduce postoperative pain and analgesic medication administration for IHR in TAPP technique.
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Affiliation(s)
- C Paasch
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany.
| | - J Fiebelkorn
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - N Berndt
- Medical School, Charité University Medicine Berlin, Berlin, Germany
| | - G De Santo
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - N Aljedani
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - P Ortiz
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | | | - K Boettge
- No Insurance Surgery, 9121 W Russell Rd Ste 115, Las Vegas, 89148, USA
| | - S Anders
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - H Full
- Department of Anesthesiology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - M W Strik
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
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22
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Justicz N, Gadkaree SK, Yamasaki A, Lindsay RW. Defining Typical Acetaminophen and Narcotic Usage in the Postoperative Rhinoplasty Patient. Laryngoscope 2020; 131:48-53. [PMID: 32031696 DOI: 10.1002/lary.28531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/06/2019] [Accepted: 01/02/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To characterize the acetaminophen and narcotic use pattern of the postoperative rhinoplasty patient. To describe a pain level and pain medication usage pattern of the typical post-rhinoplasty patient and identify demographic considerations. STUDY DESIGN Prospective cohort study at a tertiary care center. METHODS Rhinoplasty patients were given standardized perioperative pain instructions and narcotic medication (18 tabs oxycodone) along with a pain medication use survey. Postoperatively, survey and tracking information was collected regarding narcotic and acetaminophen use at their first postoperative appointment. Patients were asked about non-steroidal anti-inflammatory drug, aspirin, and chronic opioid use. Narcotic and acetaminophen use along pain levels (1-10) at time of use were recorded by patients at 4-hour increments postoperatively until their first postoperative visit. RESULTS Pain medication usage (oxycodone and acetaminophen) peaked on (postoperative day 1) POD1. Pain was significantly higher in younger patients (30 years old or younger), female patients, and primary rhinoplasty patients. Pain was correlated with acetaminophen and oxycodone use for women, and acetaminophen used for men. Autologous rib grafting was not correlated with higher narcotic use. CONCLUSION Describing a pain medication usage pattern for the typical post-rhinoplasty patient provides both patients and clinicians important knowledge of postoperative pain expectations and has the potential to reduce both the amount of narcotic prescribed by providers and the amount of narcotic used by patients. LEVEL OF EVIDENCE 4 (Case Series) Laryngoscope, 131:48-53, 2021.
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Affiliation(s)
- Natalie Justicz
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Shekhar K Gadkaree
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Alisa Yamasaki
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Robin W Lindsay
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
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23
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Sethi RKV, Lee LN, Quatela OE, Richburg KG, Shaye DA. Opioid Prescription Patterns After Rhinoplasty. JAMA FACIAL PLAST SU 2020; 21:76-77. [PMID: 30193252 DOI: 10.1001/jamafacial.2018.0999] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Rosh K V Sethi
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Linda N Lee
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Olivia E Quatela
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Kayla G Richburg
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - David A Shaye
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts
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24
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Safety of Postoperative Opioid Alternatives in Plastic Surgery: A Systematic Review. Plast Reconstr Surg 2020; 144:991-999. [PMID: 31568318 DOI: 10.1097/prs.0000000000006074] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
With the growing opioid epidemic, plastic surgeons are being encouraged to transition away from reliance on postoperative opioids. However, many plastic surgeons hesitate to use nonopioid analgesics such as nonsteroidal antiinflammatory drugs and local anesthetic blocks because of concerns about their safety, particularly bleeding. The goal of this systematic review is to assess the validity of risks associated with nonopioid analgesic alternatives. A comprehensive literature search of the PubMed and MEDLINE databases was conducted regarding the safety of opioid alternatives in plastic surgery. Inclusion and exclusion criteria yielded 34 relevant articles. A systematic review was performed because of the variation between study indications, interventions, and complications. Thirty-four articles were reviewed that analyzed the safety of ibuprofen, ketorolac, celecoxib, intravenous acetaminophen, ketamine, gabapentin, liposomal bupivacaine, and local and continuous nerve blocks after plastic surgery procedures. There were no articles that showed statistically significant bleeding associated with ibuprofen, celecoxib, or ketorolac. Similarly, acetaminophen administered intravenously, ketamine, gabapentin, and liposomal bupivacaine did not have any significant increased risk of adverse events. Nerve and infusion blocks have a low risk of pneumothorax. Limitations of this study include small sample sizes, different dosing and control groups, and more than one medication being studied. Larger studies of nonopioid analgesics would therefore be valuable and may strengthen the conclusions of this review. As a preliminary investigation, this review showed that several opioid alternatives have a potential role in postoperative analgesia. Plastic surgeons have the responsibility to lead the reduction of postoperative opioid use by further developing multimodal analgesia.
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25
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Li P, Zheng X, Wu Y, Peng J. The efficacy of parecoxib for pain control after hysterectomy: a meta-analysis of randomized controlled studies. J Matern Fetal Neonatal Med 2019; 34:3488-3495. [PMID: 31809616 DOI: 10.1080/14767058.2019.1685972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: The efficacy of parecoxib for pain control after hysterectomy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of parecoxib versus placebo on pain intensity after hysterectomy.Methods: We search PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases through March 2019 for randomized controlled trials (RCTs) assessing the effect of parecoxib versus placebo on pain intensity after hysterectomy. This meta-analysis is performed using the random-effect model.Results: Six RCTs are included in the meta-analysis. Overall, compared with control group after hysterectomy, parecoxib treatment is associated with substantially reduced pain scores in 4-6 h at rest (MD = -0.98; 95%CI = -1.14 to -0.81; p < .00001), pain scores in 12 h at rest (MD = -0.70; 95%CI = -0.77 to -0.63; p < .00001), pain scores in 12 h on sitting up (MD = -0.90; 95%CI = -1.03 to -0.77; p < .00001), pain scores in 24 h on sitting up (MD = -1.19; 95%CI = -1.94 to -0.44; p = .002), dose of analgesic need in parecoxib group is notably lower than that in control group (std. MD = -2.54; 95%CI = -3.97 to -1.10; p = .0005), but shows no obvious effect on pain scores in 24 h at rest (MD = -0.40; 95%CI = -1.47-0.67; p = .47), pain scores in 4-6 h on sitting up (MD = -0.54; 95%CI = -2.50-1.42; p = .59), first time to analgesic requirement between two groups (std. MD = -0.10; 95%CI = -0.47-0.26; p = .57), nausea or vomiting (RR = 0.92; 95%CI = 0.59-1.43; p = .70), and adverse events (RR = 0.86; 95%CI = 0.64-1.17; p = .34).Conclusions: Parecoxib treatment provides additional benefits for pain control after hysterectomy.
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Affiliation(s)
- Peipei Li
- Department of Obstetrics and Gynecology, Wenzhou People's Hospital, Wenzhou, China
| | - Xiaodong Zheng
- Department of Obstetrics and Gynecology, Wenzhou People's Hospital, Wenzhou, China
| | - Yumin Wu
- Department of Obstetrics and Gynecology, Wenzhou People's Hospital, Wenzhou, China
| | - Jiwen Peng
- Department of Obstetrics and Gynecology, Wenzhou People's Hospital, Wenzhou, China
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26
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Erector Spinae Plane Block Decreases Pain and Opioid Consumption in Breast Surgery: Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2525. [PMID: 31942313 PMCID: PMC6908334 DOI: 10.1097/gox.0000000000002525] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/11/2019] [Indexed: 12/16/2022]
Abstract
Adequate control of acute postoperative pain is crucial in breast surgeries, as it is a significant factor in the development of persistent chronic pain. Inadequate postoperative pain control increases length of hospital stays and risk of severe complications. Erector spinae plane block (ESPB) is a novel regional block that has the ability to sufficiently block unilateral multidermatomal sensation from T1 to L3. By reviewing the literature on ESPB, this paper aimed to elucidate its efficacy in breast surgery analgesia and its role in addressing the opioid crisis in North America.
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27
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Uhlmann RA, Reinhart HA, Postevka E, Snyder SK, Romero Arenas M. A Review of Postoperative Pain Management for Thyroid and Parathyroid Surgery. J Surg Res 2019; 241:107-111. [DOI: 10.1016/j.jss.2019.03.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 03/03/2019] [Accepted: 03/22/2019] [Indexed: 12/16/2022]
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28
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Differences in Opioid Prescribing Practices among Plastic Surgery Trainees in the United States and Canada. Plast Reconstr Surg 2019; 144:126e-136e. [DOI: 10.1097/prs.0000000000005780] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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29
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Non-narcotic Perioperative Pain Management in Prosthetic Breast Reconstruction During an Opioid Crisis: A Systematic Review of Paravertebral Blocks. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2299. [PMID: 31624690 PMCID: PMC6635209 DOI: 10.1097/gox.0000000000002299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/24/2019] [Indexed: 12/27/2022]
Abstract
Background: Alternatives to postoperative, narcotic pain management following implant-based, postmastectomy breast reconstruction (IBR) must be a focus for plastic surgeons and anesthesiologists, especially with the current opioid epidemic. Paravertebral blocks (PVBs) are a regional technique that has demonstrated efficacy in patients undergoing a variety of breast cancer–related surgeries. However, a specific understanding of PVB’s efficacy in pain management in patients who undergo IBR is lacking. Methods: A systematic search of PubMed, EMBASE, and Cochrane Library electronic database was conducted to examine PVB administration in mastectomy patients undergoing IBR. Data were abstracted regarding: authors, publication year, study design, patient demographics, tumor laterality, tumor stage, type, and timing of reconstruction. The primary outcome was PVB efficacy, represented as patient-reported pain scores. Secondary outcomes of interest include narcotic consumption, postoperative nausea and vomiting, antiemetic use, and length of stay. Results: The search resulted in 1,516 unique articles. After title and abstract screening, 29 articles met the inclusion criteria for full-text review. Only 7 studies were included. Of those, 2 studies were randomized control trials and 5 were retrospective cohort studies. Heterogeneity of included studies precluded a meta-analysis. Overall, PVB patients had improved pain control, and less opioid consumption. Conclusion: PVBs are a regional anesthesia technique which may aid in pain management in the breast reconstructive setting. Evidence suggests that PVBs aid in controlling acute postoperative pain, reduce opioid consumption, and improve patient length of stay. However, some conflicting findings demonstrate a need for continued research in this area of pain control.
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30
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Torabi R, Bourn L, Mundinger GS, Saeg F, Patterson C, Gimenez A, Wisecarver I, St. Hilaire H, Stalder M, Tessler O. American Society of Plastic Surgeons Member Post-Operative Opioid Prescribing Patterns. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2125. [PMID: 31044107 PMCID: PMC6467612 DOI: 10.1097/gox.0000000000002125] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Despite the widespread use of opioids in pain management, there are currently no evidence-based guidelines for the treatment of postoperative pain with opioids. Although other surgical specialties have begun researching their pain prescribing patterns, there has yet to be an investigation to unravel opioid prescribing patterns among plastic surgeons. METHODS Survey Monkey was used to sample the American Society of Plastic Surgeons (ASPS) members regarding their opioid prescribing practice patterns. The survey was sent randomly to 50% of ASPS members. Respondents were randomized to 1 of 3 different common elective procedures in plastic surgery: breast augmentation, breast reduction, and abdominoplasty. RESULTS Of the 5,770 overall active ASPS members, 298 responses (12% response rate) were received with the following procedure randomization results: 106 for breast augmentation, 99 for breast reduction, and 95 for abdominoplasty. Overall, 80% (N = 240) of respondents used nonnarcotic adjuncts to manage postoperative pain, with 75.4% (N = 181) using nonnarcotics adjuncts >75% of the time. The most commonly prescribed narcotics were Hydrocodone with Acetaminophen (Lortab, Norco) and Oxycodone with Acetaminophen (Percocet, Oxycocet) at 42.5% (N = 116) and 38.1% (N = 104), respectively. The most common dosage was 5 mg (80.4%; N = 176), with 48.9% (N = 107) mostly dispensing 20-30 tablets, and the majority did not give refills (94.5%; N = 207). CONCLUSIONS Overall, plastic surgeons seem to be in compliance with proposed American College of Surgeon's opioid prescription guidelines. However, there remains a lack of evidence regarding appropriate opioid prescribing patterns for plastic surgeons.
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Affiliation(s)
- Radbeh Torabi
- From the Department of Surgery, Section of Plastic & Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, La
| | - Lynn Bourn
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, La
| | - Gerhard S. Mundinger
- From the Department of Surgery, Section of Plastic & Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, La
| | - Fouad Saeg
- School of Medicine, Tulane University, New Orleans, La
| | - Charles Patterson
- From the Department of Surgery, Section of Plastic & Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, La
| | - Alejandro Gimenez
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, La
| | - Ian Wisecarver
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, La
| | - Hugo St. Hilaire
- From the Department of Surgery, Section of Plastic & Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, La
| | - Mark Stalder
- From the Department of Surgery, Section of Plastic & Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, La
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Opioid Prescribing and Consumption Patterns following Outpatient Plastic Surgery Procedures. Plast Reconstr Surg 2019; 143:929-938. [DOI: 10.1097/prs.0000000000005351] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Salazar L, Findlay L. Implementation and Evaluation of an Opioid Risk Questionnaire in the Outpatient Plastic Surgery Setting. Plast Surg Nurs 2019; 39:136-141. [PMID: 31790042 DOI: 10.1097/psn.0000000000000278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Most patients undergoing plastic and cosmetic surgery are prescribed an opioid for postoperative pain control. With the advent of the opioid epidemic in our country, screening for opioid risk has become a topic of many health care discussions. However, there has been little mention of using an opioid risk questionnaire specific to the outpatient plastic surgery setting. This project consisted of distribution of an opioid risk questionnaire to adult patients undergoing outpatient plastic surgery. Data were collected at preoperative appointments from participating patients (n = 27). Although the sample size was small, two patients (7%) were identified as having a history of substance abuse, and both of those patients reported they had also received treatment for their substance abuse. In addition, six patients (22%) reported having a family history of substance abuse. Such findings suggest that clinicians working in outpatient plastic surgery should screen their patients for substance abuse and misuse.
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Affiliation(s)
- Leah Salazar
- Leah Salazar, DNP, APRN-BC, RN, is a board-certified family nurse practitioner working in outpatient plastic and cosmetic surgery in Reno, Nevada. Lillian Findlay, PhD, APRN, is a board-certified nurse practitioner and clinical nurse specialist in psychiatric mental health and a faculty member of the University of Alabama, Tuscaloosa
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Cornett EM, Budish R, Latimer D, Hart B, Urman RD, Kaye AD. Management of Challenging Pharmacologic Issues in Chronic Pain and Substance Abuse Disorders. Anesthesiol Clin 2018; 36:615-626. [PMID: 30390782 DOI: 10.1016/j.anclin.2018.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Drug abuse and addiction are persistent problems in the United States and around the world. This is an ongoing issue for health care providers, as substance abuse is seen in 25% to 40% of patients admitted to hospitals for general treatment. Many patients with substance use disorders have a higher risk for adverse events; however, only a small percentage will volunteer information regarding prior substance use. This article discusses the present opioid crisis, mechanisms behind chronic pain and substance abuse, current clinical findings, treatment therapies, and abuse deterrents.
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Affiliation(s)
- Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Rebecca Budish
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Dustin Latimer
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Brendon Hart
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis street, Boston, MA 02115, USA
| | - Alan David Kaye
- Department of Anesthesiology, LSU Health Science Center, Room 656, 1542 Tulane Avenue, New Orleans, LA 70112, USA; Department of Pharmacology, LSU Health Science Center, Room 656, 1542 Tulane Avenue, New Orleans, LA 70112, USA
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Barker JC, DiBartola K, Wee C, Andonian N, Abdel-Rasoul M, Lowery D, Janis JE. Preoperative Multimodal Analgesia Decreases Postanesthesia Care Unit Narcotic Use and Pain Scores in Outpatient Breast Surgery. Plast Reconstr Surg 2018; 142:443e-450e. [PMID: 29979365 DOI: 10.1097/prs.0000000000004804] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The opioid epidemic demands changes in perioperative pain management. Of the 33,000 deaths attributable to opioid overdose in 2015, half received prescription opioids. Multimodal analgesia is a practice-altering evolution that reduces reliance on opioid medications. Ambulatory breast surgery is an ideal opportunity to implement these strategies. METHODS A retrospective review of 560 patients undergoing outpatient breast procedures was conducted. Patients received (1) no preoperative analgesia (n = 333); (2) intraoperative intravenous acetaminophen (n = 78); (3) preoperative oral acetaminophen and gabapentin (n = 95); or (4) preoperative oral acetaminophen, gabapentin and celecoxib (n = 54). Outcomes included postanesthesia care unit narcotic use, pain scores, postanesthesia care unit length of stay, rescue antiemetic use, and 30-day complications. RESULTS Both oral multimodal analgesia regimens significantly reduced postanesthesia care unit narcotic use (oral acetaminophen and gabapentin, 14.3 ± 1.7; oral gabapentin, acetaminophen, and celecoxib, 11.9 ± 2.2; versus no drug, 19.2 ± 1.1 mg oral morphine equivalents; p = 0.0006), initial pain scores (oral acetaminophen and gabapentin, 3.9 ± 0.4; oral gabapentin, acetaminophen, and celecoxib, 3.4 ± 0.7; versus no drug, 5.3 ± 0.3 on a 1 to 10 scale, p = 0.0002) and maximum pain scores (oral acetaminophen and gabapentin, 4.3 ± 0.4; oral gabapentin, acetaminophen, and celecoxib, 3.6 ± 0.7; versus no drug, 5.9 ± 0.3 on a 1 to 10 scale; p < 0.0001). Both oral regimens were better than no medications or intravenous acetaminophen alone in multivariate models after controlling for age, body mass index, American Society of Anesthesiologists class, length of surgery, prior narcotic prescription availability, and intraoperative local anesthetic. Postanesthesia care unit length of stay, antiemetic use, and 30-day complications were not different. CONCLUSIONS Preoperative oral multimodal analgesia reduces narcotic use and pain scores in outpatient breast plastic surgery. These regimens are inexpensive, improve pain control, and contribute to narcotic-sparing clinical practice in the setting of a national opioid epidemic. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Jenny C Barker
- From the Departments of Plastic Surgery, Anesthesia, and Biomedical Informatics, Center for Biostatistics, The Ohio State University Medical Center
| | - Kaitlin DiBartola
- From the Departments of Plastic Surgery, Anesthesia, and Biomedical Informatics, Center for Biostatistics, The Ohio State University Medical Center
| | - Corinne Wee
- From the Departments of Plastic Surgery, Anesthesia, and Biomedical Informatics, Center for Biostatistics, The Ohio State University Medical Center
| | - Nicole Andonian
- From the Departments of Plastic Surgery, Anesthesia, and Biomedical Informatics, Center for Biostatistics, The Ohio State University Medical Center
| | - Mahmoud Abdel-Rasoul
- From the Departments of Plastic Surgery, Anesthesia, and Biomedical Informatics, Center for Biostatistics, The Ohio State University Medical Center
| | - Deborah Lowery
- From the Departments of Plastic Surgery, Anesthesia, and Biomedical Informatics, Center for Biostatistics, The Ohio State University Medical Center
| | - Jeffrey E Janis
- From the Departments of Plastic Surgery, Anesthesia, and Biomedical Informatics, Center for Biostatistics, The Ohio State University Medical Center
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Cohen-Mekelburg S, Rosenblatt R, Gold S, Burakoff R, Waljee AK, Saini S, Schackman BR, Scherl E, Crawford C. The Impact of Opioid Epidemic Trends on Hospitalised Inflammatory Bowel Disease Patients. J Crohns Colitis 2018; 12:1030-1035. [PMID: 29741667 PMCID: PMC6113704 DOI: 10.1093/ecco-jcc/jjy062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/25/2018] [Accepted: 05/05/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Opioid use disorder [OUD] has become a public health crisis among patients with chronic disease. Inflammatory bowel disease [IBD] patients are at high risk for OUD because they suffer from chronic relapsing-remitting pain. We aimed to describe the prevalence and trends in OUD-related diagnoses among hospitalised IBD patients. METHODS A retrospective study was performed using weighted Nationwide Inpatient Sample data from 2005 to 2014. Adult IBD hospital visits and OUD-related diagnoses were identified using a previously published schema. Annual diagnoses were calculated. Characteristics associated with OUD were assessed using multivariable logistic regression. Associations between OUD and length of stay were assessed overall and separately for surgical and non-surgical stays. RESULTS In all, 2.2% of 2585174 weighted discharges with any diagnosis of IBD also had an OUD-related diagnosis, with an 8.8% average annual increase. In multivariable analysis, Crohn's disease, public payer or no insurance, and psychiatric comorbidities were associated with a higher likelihood of OUD, whereas a primary diagnosis of an IBD-related complication was associated with a lower likelihood. An OUD-related diagnosis was associated with 0.84 days (95% confidence interval [CI] 0.71, 0.97] increased length of stay overall, 2.79 days [95% CI 1.44, 4.14] for surgical stays, and 0.71 days [95% CI 0.59, 0.82] for non-surgical stays. CONCLUSIONS OUD-related diagnoses are increasing among IBD patients and are associated with increased length of stay. With a rising prevalence, it is important to screen and diagnose OUD in IBD and refer patients for evidence-based treatment to address unmet patient needs and reduce health care utilisation.
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Affiliation(s)
- Shirley Cohen-Mekelburg
- Division of Gastroenterology & Hepatology, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA,Corresponding author: Shirley Cohen-Mekelburg, MD, 1305 York Avenue, 4th floor, New York, NY 10021, USA. Tel.: 646-962-4800; fax: 646-962-0399;
| | - Russell Rosenblatt
- Division of Gastroenterology & Hepatology, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Stephanie Gold
- Department of Medicine, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Robert Burakoff
- Division of Gastroenterology & Hepatology, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Akbar K Waljee
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA,VA Ann Arbor Health Services Research and Development Center of Clinical Management Research, Ann Arbor, MI, USA
| | - Sameer Saini
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA,VA Ann Arbor Health Services Research and Development Center of Clinical Management Research, Ann Arbor, MI, USA
| | - Bruce R Schackman
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA
| | - Ellen Scherl
- Division of Gastroenterology & Hepatology, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Carl Crawford
- Division of Gastroenterology & Hepatology, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA
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Bartlett EL, Zavlin D, Friedman JD, Abdollahi A, Rappaport NH. Enhanced Recovery After Surgery: The Plastic Surgery Paradigm Shift. Aesthet Surg J 2018; 38:676-685. [PMID: 29253084 DOI: 10.1093/asj/sjx217] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND With a focus on providing high quality care and reducing facility based expenses there has been an evolution in perioperative care by way of enhanced recovery after surgery (ERAS). ERAS allows for a multidisciplinary and multimodal approach to perioperative care which not only expedites recovery but maximizes patient outcomes. This paradigm shift has been generally accepted by most surgical specialties, including plastic surgery. OBJECTIVES The goal of this study was to evaluate the impact of ERAS on outcomes in cosmetic plastic surgery. METHODS A prospective study consisting of phone call questionnaires was designed where patients from two senior plastic surgeons (N.H.R. and J.D.F.) were followed. The treatment group (n = 10) followed an ERAS protocol while the control group (n = 12) followed the traditional recovery after surgery which included narcotic usage. Patients were contacted on postoperative days (POD) 0 through 7+ and surveyed about a number of outcomes measures. RESULTS The ERAS group demonstrated a significant reduction in postoperative pain on POD 0, 1, 2, and 3 (all P < 0.01). There was also statistically less nausea/vomiting, fatigue/drowsiness, constipation, and hindrance on ambulation compared to the control group (all P < 0.05). Significance was achieved for reduction in fatigue/drowsiness on POD 0 and 1 (P < 0.01), as well as ability to ambulate on POD 0 and 3 (P = 0.044). Lastly, opioid use (P < 0.001) and constipation (P = 0.003) were decreased. CONCLUSIONS ERAS protocols have demonstrated their importance within multiple surgical fields, including cosmetic plastic surgery. The utility lies in the ability to expedite patient's recovery while still providing quality care. This study showed a reduction in postoperative complaints by avoiding narcotics without an increase in complications. Our findings signify the importance of ERAS protocols within cosmetic plastic surgery. LEVEL OF EVIDENCE 4
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Affiliation(s)
- Erica L Bartlett
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
| | - Dmitry Zavlin
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
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