Plastic and reconstructive surgery
-
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.
-
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.
-
Plast. Reconstr. Surg. · Oct 2014
Putting it all together: recommendations for improving pain management in plastic surgical procedures: hand surgery.
Approaches to upper extremity anesthesia in hand surgery include regional blocks, wide-awake hand surgery with local anesthesia, and stellate ganglion blocks. ⋯ Pain management in hand surgery can be achieved through regional blocks and wide-awake techniques that do not necessitate general anesthesia in an effort to improve safety, convenience, cost savings, and efficiency.
-
Plast. Reconstr. Surg. · Oct 2014
Putting it all together: recommendations for improving pain management in plastic surgical procedures-surgical facial rejuvenation.
Postoperative pain is a major concern for patients undergoing facial aesthetic surgery. Aggressive efforts to reduce postoperative pain while avoiding adverse sequelae, such as nausea and vomiting, will result in an improved patient experience. Newer pharmaceuticals, medical devices, and longer-acting local anesthetics offer the potential to reduce pain and enhance patient satisfaction. The purpose of this report is to review the options and apply them to 3 specific facial aesthetic procedures: face-lift, brow lift, and blepharoplasty. ⋯ Recent advances in postoperative pain control can significantly improve the patient's surgical experience. This multimodal therapy includes new pharmaceuticals, longer-acting local anesthetics, and devices designed to minimize postoperative pain. Adoption of these techniques may also reduce the need for narcotics and prevent postoperative adverse sequelae.
-
Plast. Reconstr. Surg. · Oct 2014
Nonendoscopic deactivation of nerve triggers in migraine headache patients: surgical technique and outcomes.
Low efficacy, significant side effects, and refractory patients often limit the medical treatment of migraine headache. However, new surgical options have emerged. Dr. Bahman Guyuron and others report response rates between 68 and 95 percent after surgical deactivation of migraine trigger sites in select patients. In an effort to replicate and expand migraine trigger-site deactivation surgery as a treatment option, the authors' group and others have developed nonendoscopic algorithms. The exclusion of endoscopic techniques may be useful for surgeons with little experience or limited access to the endoscope and in patients with challenging anatomy. ⋯ Therapeutic, IV.