Comparison of Multimodal Analgesia and Narcotic Regimen for Postoperative Pain Control of Plastic Surgery Breast Procedures.

Abstract

Background: Opioid analgesics are commonly used for postoperative pain management in plastic surgery, despite risks regarding dependence and complications. This study evaluates the noninferiority of multimodal analgesia compared with traditional narcotic regimens for postoperative pain management in breast reduction mammoplasty and tissue expander placement following mastectomy.

Methods: A retrospective cohort study of 171 patients (107 breast reduction, 64 tissue expander placement) was conducted at a single tertiary academic medical center between 2018 and 2022. Patients received either multimodal analgesia (preoperative acetaminophen 1000 mg, postoperative tramadol 50 mg q6h PRN, and gabapentin 300 mg TID) or narcotic analgesia (hydrocodone-acetaminophen 5-325 mg q6h PRN). Pain intensity was measured using Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity scores at the 2-week postoperative visit. Supplemental pain medication requests were tracked for analgesic groups as a measure of inadequate pain control.

Results: In the breast reduction group, the mean difference in PROMIS scores between multimodal (57.29) and narcotic (56.24) groups was 1.05 (95% CI, -2.81-4.91), below the minimal clinically meaningful difference of 10 points. For tissue expander placement, the mean difference was -2.76 (95% CI, -8.73-3.21). No significant differences were found in supplemental medication requests between groups for either procedure (P > .05).

Conclusions: Multimodal analgesia provides pain control comparable to traditional narcotic regimens in breast procedures. This approach may reduce opioid exposure with comparable patient-reported outcomes, supporting multimodal analgesic protocols as a strategy to mitigate opioid use in plastic surgery patients.