Role of ropivacaine infiltration analgesia in bilateral reduction mammaplasty

INTRODUCTION

Bilateral reduction mammaplasty (BRM) is a common procedure in plastic surgery. Our study aims to determine whether single-shot infiltration with ropivacaine during surgery reduces postoperative pain and decreases analgesic consumption.

METHODS

In a prospective and monocentric study, all women operated by a single senior plastic surgeon, for whom BRM had been performed were included. The same surgical technique was performed for all patients (a superior pedicle, wise-pattern BRM with a closed-suction drainage). During the first half first part of the study period, none of the patients received ropivacaine infiltration (control group) and during the second half, all the patients received this infiltration (ropivacaine group). Infiltration was performed with a 20 mL solution of ropivacaine per side. Analgesic consumption and pain intensity were recorded during hospitalization and following discharge.

RESULTS

Forty-nine patients were divided into two groups (29 in the ropivacaine group and 20 in the control group). The ropivacaine group had a significantly lower consumption than the control group on all analgesics (paracetamol, tramadol, nefopam and morphin) (P < 0.001). Pain measurement reflected significantly lower scores in the ropivacaine group, both at four hours and three days postoperatively (P < 0.001). This difference was no longer significant at day 7 postoperatively (P=0.147).

CONCLUSION

Single-shot ropivacaine infiltration during surgery reduces postoperative pain and decreases the analgesic consumption. With this peroperative infiltration, BRM can be performed with good pain control and moderate analgesic consumption, limiting side effects.

[Evaluation of a short incision double eyelidplasty for Asian patients]

BACKGROUND

Creation of a double upper eyelid is a popular procedure in Asian countries. Many incisional and non-incisional approaches have been described to create a new suprapalpebral fold.

OBJECTIVE

The authors recommended a short incision technique to create a double eyelid and evaluated the results.

METHODS

The location of the partial incision was determined pre-operatively with the patient. A one-centimeter partial incision was made on the middle one-third of the upper eyelid, and the orbicularis oculi muscle was dissected. Three anchoring stitches were placed for the creation of the permanent suprapalpebral fold. Those stitches were inverted single knots which linked the tarsal plate to the lower margin's dermis or dermomuscular junction of the incised skin. Intra-operative adjustment of position and curvature of the new fold was done by the active opening of the upper eyelid. Global results, symmetry and design were evaluated by the patient and one independent surgeon.

RESULTS

Between January 2012 and January 2013, a total of 10patients were operated using this technique. All patients were satisfied, with 8results graded excellent and 2results graded good. The average operation time was 20minutes. There were no serious complications, the only unfavorable outcome was one persistent bruise. The follow-up period was one year. Recovery time varied from 2weeks to a month. No correction procedure was needed.

CONCLUSIONS

The short central incisional technique for creation of a double eyelid described here provides excellent permanent and natural results, with no visible scar nor serious complications.