title: Pre-incision infiltration with lidocaine reduces pain and opioid consumption after reduction mammoplasty.
abstract: OBJECTIVE
  To determine the analgesic efficacy of preoperative tumescent infiltration with lidocaine for reduction mammoplasty.
  
  
  METHODS
  Women with mammary hypertrophy were randomly allocated to one of two study groups in a double-blind clinical trial. Patients in group 1 received preincision infiltration with 5 mL/kg of 0.35% lidocaine with 1:1,000,000 epinephrine into each breast after induction of general anesthesia. Group 2 patients received similar injections of 5 mL/kg of saline with 1:1,000,000 epinephrine. Intravenous patient-controlled analgesia (PCA) morphine (1.0 mg bolus with 5-minute lockout) was available for 9.5 hours in the postoperative period. Visual analog pain scores were recorded during the postoperative period, and hourly morphine consumption data were retrieved from the PCA apparatus. Fitness for discharge was evaluated by the postanesthesia care unit nurse using standardized discharge criteria.
  
  
  RESULTS
  Visual analog pain scores were higher in group 2 patients until 3.5 hours after surgery. Patients in the saline group had higher intravenous morphine consumption during all 1-hour postoperative intervals, although the differences between groups were statistically significant only until 4.5 hours after the operation. Total intravenous morphine consumption during the first 9.5 hours after surgery in group 1 was 16.9+/-11.9 mg versus 31.1+/-18.0 mg in group 2 (P < .05). Postoperative nausea and vomiting occurred with equal frequency (87%) in both study groups, and there was no difference between groups in time to achieve fitness for discharge, i.e., a postanesthesia discharge score of > or = 9.
  
  
  CONCLUSIONS
  Preoperative tumescent infiltration with lidocaine results in reduced pain and lower postoperative opioid requirements in the initial hours after reduction mammoplasty.
authors.affiliation: Department of Anaesthesia, Ottawa Civic Hospital, University of Ottawa, Ontario, Canada.
authors.forename: O P
authors.initials: OP
authors.lastname: Rosaeg
authors.forename: M
authors.initials: M
authors.lastname: Bell
authors.forename: N J
authors.initials: NJ
authors.lastname: Cicutti
authors.forename: K C
authors.initials: KC
authors.lastname: Dennehy
authors.forename: A C
authors.initials: AC
authors.lastname: Lui
authors.forename: B
authors.initials: B
authors.lastname: Krepski
mesh_terms: D000322:Adrenergic Agonists / Q000008:administration & dosage; D000328:Adult; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000762:Anesthesia Recovery Period; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001940:Breast / Q000187:drug effects*; D062109:Dermatologic Surgical Procedures; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008012:Lidocaine / Q000008:administration & dosage*; D016462:Mammaplasty; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010351:Patient Discharge; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D012867:Skin / Q000187:drug effects*; D012965:Sodium Chloride
chemical_list: D000322:Adrenergic Agonists; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D012965:Sodium Chloride; D009020:Morphine; D008012:Lidocaine; D004837:Epinephrine