Non-narcotic Pain Management after Primary Aesthetic Breast Surgery

Abstract

BACKGROUND: The opioid epidemic continues to be a major health issue and major cause of death in the United States. Alternative pain regimens for elective operations are a priority to aid in decreasing complications from opioid use. Aside from simply limiting the quantity of narcotic medications prescribed, the plastic surgery literature has begun to explore alternative options for postoperative pain control by evaluating both effectiveness and safety profiles. The purpose of this study was to evaluate effectiveness and safety of a nonopioid pain regimen for patients after primary aesthetic breast surgery. METHODS: Inclusion criteria captured all consecutive patients over 18 years of age who underwent primary breast surgery, including augmentation or augmentation in combination with mastopexy. They were to use acetaminophen 1000 mg every 8 hours as needed, ibuprofen 800 mg every 8 hours as needed, and cyclobenzaprine 10 mg every 8 hours. All patients also received one dose of 30 mg ketorolac in the recovery unit. The seventy included patients were given a survey regarding pain control and side effects of medications after their operation to evaluate both effectiveness and safety of their non-narcotic regimen. Primary outcomes collected were effectiveness of pain regimen rated on a scale of 1–5 and any side effects from medications. RESULTS: The majority of patients (60.0%) reported the effectiveness of their pain control as 5 out of 5. Ten (14.3%) patients rated 4 out of 5, 11 patients (15.7%) 3 out of 5, one patient (1.4%) 2 out of 5, and six patients (8.6%) 1 out of 5. Only 10 patients (14.3%) reported side effects related to their medication. Seven patients had drowsiness, two had constipation, and one reported upset stomach with ibuprofen. One patient (1.4%) needed evacuation of hematoma on postoperative day #0. Level of postoperative pain control did not appear to correlate with volume of implants placed. CONCLUSIONS: The non-narcotic pain medication regimen using acetaminophen, ibuprofen, and cyclobenzaprine proved to be both safe and effective in this group of primary aesthetic breast surgery patients. The importance of exploring nonopioid therapy cannot be emphasized enough in the face of today’s crisis. Conclusively, no ideal regimen has been determined to date; however, its importance continues to mandate further exploration on this crucial topic.