Comparison of immediate postoperative pain in implant-based breast reconstructions

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 69; no. 5; pp. 604 - 616
• Main Authors: Gassman, Andrew A, Yoon, Alfred P, Festekjian, Jaco, Da Lio, Andrew L, Tseng, Charles Y, Crisera, Chris
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.05.2016
• Subjects: Analgesia, Patient-Controlled; Analgesics, Non-Narcotic - administration & dosage; Analgesics, Opioid - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Breast Implants - adverse effects; Breast reconstruction; Female; Humans; Length of Stay; Mammaplasty - adverse effects; Mammaplasty - methods; Mammaplasty - statistics & numerical data; Morphine - administration & dosage; Pain control; Pain Management - methods; Pain Measurement - statistics & numerical data; Pain, Postoperative - diagnosis; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Plastic Surgery; Silicone implant; Tissue expander; Tissue Expansion Devices - adverse effects; Silicone implant; Tissue expander; Pain control; Breast reconstruction
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2015.12.009

Summary Background Implant-based techniques represent the most common form of breast reconstruction. However, substantial postoperative pain has been associated with implant-based breast reconstruction. Objective The objective of this study is to evaluate immediate postoperative pain in implant-based breast reconstruction. Methods We reviewed 378 patients who underwent implant-based reconstruction between January 2004 and December 2012. Each patient's visual analog scale (VAS) score, pain medication, and patient-controlled analgesia (PCA) attempts were used to assess in-hospital postoperative pain. We evaluated timing of reconstruction post mastectomy, tissue expander (TE) designed fill volume, TE initial fill volume, and single-stage immediate implant (II) versus TE reconstruction. Results No significant differences in pain parameters were noted between the immediate and delayed postmastectomy reconstruction cohorts. TEs with larger (>300 cc) designed volumes required significantly more narcotic use ( p  = 0.02) and PCA attempts ( p  < 0.01). Narcotic use was higher in the larger (>250-cc) TE initial fill group starting on postoperative day 2, but overall differences in VAS score and PCA attempts were not significant. Morphine equivalence ( p  < 0.01) and non-opioid oral analgesic use (average p  = 0.03) of the TE cohort were significantly higher than those of the II cohort. Conclusion Patients undergoing TE-based implant reconstruction show greater analgesic use than those with single-stage II-based reconstruction. This may indicate a higher immediate postoperative pain in TE procedures than in II procedures. Furthermore, higher initial fill and designed volume of TE require more morphine equivalence postoperatively. These findings may warrant further preoperative discussion for better pain management and patient satisfaction.