title: Comparison of postoperative pain control in autologous abdominal free flap versus implant-based breast reconstructions.
abstract: BACKGROUND
  Women who undergo mastectomy and breast reconstruction are shown to express more pain than those who undergo mastectomy alone. The authors evaluated postoperative pain outcomes following breast reconstruction.
  
  
  METHODS
  Patients undergoing primary implant-based (n = 1038) or flap-based (n = 837) reconstructions from 2004 to 2012 at the University of California, Los Angeles, were evaluated. Postoperative pain was measured using the visual analogue scale, total narcotic use, and number of patient-controlled analgesia attempts. Narcotic dosage was standardized to morphine equivalents per kilogram. The authors modeled postoperative narcotic use, patient-controlled analgesia attempts, and visual analogue scale scores over time using spline graphs for comparison between the two reconstruction methods.
  
  
  RESULTS
  Both total narcotic use and patient-controlled analgesia attempts were higher in the implant-based group throughout the immediate postoperative period. Implant-based reconstruction patients had significantly higher visual analogue scale scores (p < 0.0001) and total narcotic use (p < 0.0001) through postoperative day 3 compared with autologous tissue-based reconstruction patients. When controlling for reconstruction method, bilateral procedures were more painful (visual analogue scale score and patient-controlled analgesia attempts, both p < 0.001). When controlling for laterality, unilateral implant-based and autologous reconstructions had comparable visual analogue scale scores (p = 0.38) and patient-controlled analgesia attempts. However, unilateral implant-based procedures required more narcotic use than unilateral autologous tissue-based procedures (p = 0.0012).
  
  
  CONCLUSIONS
  Although commonly perceived as a less distressing operation, implant-based breast reconstruction may be more painful during the immediate postoperative hospitalization than abdominally based free tissue transfer.
  
  
  METHODS
  Therapeutic, III.
authors: Los Angeles, Calif. From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine.
authors: Andrew A
authors: AA
authors: Gassman
authors: Alfred P
authors: AP
authors: Yoon
authors: Justin B
authors: JB
authors: Maxhimer
authors: Ivan
authors: I
authors: Sanchez
authors: Harleen
authors: H
authors: Sethi
authors: Kevin W
authors: KW
authors: Cheng
authors: Charles Y
authors: CY
authors: Tseng
authors: Jaco H
authors: JH
authors: Festekjian
authors: Andrew L
authors: AL
authors: Da Lio
authors: Chris A
authors: CA
authors: Crisera
mesh_terms: D034861:Abdominal Wall; D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000706:statistics & numerical data; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008408:Mastectomy / Q000009:adverse effects; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*; D012189:Retrospective Studies; D013524:Surgical Flaps
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D009294:Narcotics; D001569:Benzodiazepines
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