Painless, Drainless Lipoabdominoplasty: A Retrospective Study of Pain Following Lipoabdominoplasty Utilizing Liposomal Bupivacaine and a Modified Enhanced Recovery After Surgery Protocol.

Abstract

BackgroundThere are many functional and aesthetic benefits to lipoabdominoplasty (combination of liposuction with abdominoplasty), including increase in core strength, reduction in urinary incontinence, and improvement in lower back pain. However, patients are still hesitant to undergo surgery due to the perceived fears of postsurgical drains, and postoperative pain.ObjectivesTo propose a standardized multimodal pain protocol for patients undergoing lipoabdominoplasty procedures that aims to improve postoperative pain control.MethodsA total of 80 patients operated on between July 2020 and December 2021 were evaluated in this study. Patients all underwent lipoabdominoplasty and were administered a standardized preoperative, intraoperative, and postoperative pain regimen. Pain scores were measured across all patients in the immediate postoperative period, and postoperative days (PODs) 1, 7, 28, and 90.ResultsMean pain scores in the postanesthesia recovery unit were 0.46/10 (+/− 0.18). Subsequent reassessment in the postop recovery suite yielded mean pain scores of 0.34 (+/− 0.15). Mean pain scores on POD1 were 1.23 (+/− 0.15) and consistent through to POD7 at 1.24 (+/− 0.11) with patients taking an average of 6.65 total Percocet 5 mg (Endo Pharmaceuticals Inc., Malvern, PA) during the week. After POD7, 95% (76/80) of patients were only taking nonsteroidal anti-inflammatory drugs. A total of 75/80 patients (93.75%) reported zero pain at 4 to 6 weeks after surgery (mean pain score 0.10 +/− 0.08).ConclusionsThe multimodal analgesia protocol consisting of preoperative or immediate induction intravenous Tylenol (Johnson & Johnson, New Brunswick, NJ), precut local analgesia with Marcaine (Pfizer Inc., New York, NY) and lidocaine, and intraoperative use of liposomal bupivacaine can improve perioperative pain control in patients undergoing lipoabdominoplasty. Level of Evidence: 4