Use of abdominal field block injections with liposomal bupivicaine to control postoperative pain after abdominoplasty.
BACKGROUND
It is well known that improving postoperative pain control in plastic surgery procedures leads to earlier mobilization, shortened hospital stay, reduced hospital costs, and increased patient satisfaction.


OBJECTIVE
The authors evaluate the use of abdominal field block injections with liposomal bupivicaine (Exparel; Pacira Pharmaceuticals, Inc, San Diego, California) in postoperative pain management in patients undergoing abdominoplasty with rectus plication.


METHODS
Case records from 64 female patients who underwent abdominoplasty with rectus plication were reviewed. We performed a total of 118 abdominoplasties with rectus plication, alone or in combination with other surgical procedures, from August 2012 to December 2012, but 54 patients were excluded from the series due to inadequate follow-up. Patients received liposomal bupivicaine injections in an abdominal field block fashion. Patient age, height, weight, and smoking status were recorded. Delivery of standardized postoperative intramuscular or intravenous injections and oral pain pills was recorded. Postoperative data and questionnaires were used to evaluate clinical efficacy.


RESULTS
The average number of procedures (including abdominoplasty with rectus plication) per patient was 7. Average patient body mass index was 27 kg/m(2). Average pain scores were 3.5 (postoperative visit 1) and 2.8 (visit 2). The average number of oral pain pills required was 14 at the first postoperative visit and 11.5 at the second postoperative visit. Patients were able to resume normal activity at an average of 6.4 days.


CONCLUSIONS
Our experience with liposomal bupivicaine injections for regional blocks in abdominoplasty with rectus plication indicates that patients experienced reduced postoperative pain, required less postoperative narcotic medication, and resumed both earlier ambulation and normal activity. Further investigation is warranted with more clinical cases to recommend the use of this medication for routine pain management after an abdominoplasty.
Drs Morales Jr, Mentz, Newall, and Patronella are plastic surgeons in private practice in Houston, Texas.
Rolando
R
Morales
Henry
H
Mentz
Germán
G
Newall
Christopher
C
Patronella
Oscar
O
Masters
D061645:Abdominoplasty / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007267:Injections; D008081:Liposomes; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D020127:Recovery of Function; D017568:Rectus Abdominis / Q000601:surgery; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D008081:Liposomes; D002045:Bupivacaine
abdominoplasty; liposomal bupivicaine; postoperative pain