Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Oct 2014
Randomized Controlled TrialPreemptive analgesia with bupivacaine in reduction mammaplasty: a prospective, randomized, double-blind, placebo-controlled trial.
Preincisional analgesia is an antinociceptive treatment that prevents altered central excitability from high-intensity noxious stimuli. To determine the analgesic efficacy of preoperative infiltration with bupivacaine for reduction mammaplasty, a randomized, double-blind, placebo-controlled trial was designed. ⋯ Therapeutic, I.
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Plast. Reconstr. Surg. · Oct 2014
Enhanced recovery after surgery pathway for abdominal wall reconstruction: pilot study and preliminary outcomes.
Enhanced recovery after surgery (ERAS) pathways represent a multimodal approach to improve the quality of postoperative care by diminishing the stress response to the trauma of an operation, thereby minimizing hospital length of stay and potentially complications. At a time when healthcare costs are being intensely scrutinized, efforts to reduce patient morbidity and hospital stay are imperative and timely. ⋯ Although hastened patient recovery is clearly multifactorial, our pathway, incorporating alvimopan, early feeding strategies, and multimodal pain therapy with an emphasis on the reduction of opiate usage as well as precise intraoperative nerve block with novel longer-acting local anesthetic Exparel, appears to provide significant improvement in postoperative pain, bowel function recovery, and shorter hospital stay. Although a prospective evaluation of the entire ERAS pathway as well as contribution of its various components is currently ongoing at our Hernia Center, we believe ours or similar ERAS pathways will soon become standard for the vast majority of patients undergoing abdominal wall surgery.
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Plast. Reconstr. Surg. · Oct 2014
Putting it all together: recommendations for pain management in nonsurgical facial rejuvenation.
Nonsurgical procedures for facial rejuvenation vastly outnumber surgical procedures among board-certified plastic surgeons; interest in nonsurgical cosmetic procedures is rapidly growing for patients and physicians, with less down time, less scars, and potentially less cost. Nonsurgical procedures are often a gateway for patients into more invasive surgical procedures. Providing patients with a comfortable, pleasant experience increases the chance of referrals and return for future procedures, surgical and nonsurgical. ⋯ A wide range of nonsurgical options exist for rejuvenation, and there is nearly as much variety in pain associated with these procedures. As with any procedure that potentially may lead to pain or anxiety for a patient, it is important to assess patient's pain tolerance preprocedurally to determine the level of intervention needed. Providing a relaxed, calm environment and satisfactory pain control helps to reduce anxiety and improve the overall perception of the procedure and provider.
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Plast. Reconstr. Surg. · Oct 2014
NMDA Receptor Antagonists, Gabapentinoids, α-2 Agonists, and Dexamethasone and Other Non-Opioid Adjuvants: Do They Have a Role in Plastic Surgery?
Inadequate pain control and opioid-related adverse effects result in delayed patient recovery and discharge times. Adjuvants help to improve the quality of analgesia and decrease opioid consumption, consequently decreasing opioid-related effects, such as nausea and vomiting, sedation, ileus, and respiratory depression. We review the mechanisms and clinical evidence for nonopioid adjuvants. ⋯ Although there is a lack of studies specifically focused in the plastic and reconstructive surgery patient population, the existing literature provides information about when the above adjuvants are likely to have the greatest impact.