Pain Management in Plastic Surgery

Most patients who undergo cosmetic surgery do not report pain during the immediate postoperative period. However, most patients who underwent liposuction combined with or without other plastic surgical procedure suffer pain after surgery. There are three main techniques in acute pain management postoperatively which are systemic analgesia, regional analgesia , and local/topical analgesia, and these are the extent of trauma during the procedure, surgeon’s skill, prior disease, location and type of incision, and psychological and cultural factors. Treatment for each type of plastic surgery and the resulting pain require techniques that can be used as single method or combined with each other to relieve postoperative pain after plastic surgery. Nausea, vomiting, constipa - tion, somnolence, etc., are well-known adverse effects of opioids. Although these effects may seem minor, they can lead to significant complications following some type of plastic surgeries, for example, face-lift hematoma following nausea and vomiting, pulmonary complications from respiratory depression, and even thromboembolic phenomena from bed rest following prolonged opioid use. Multimodal pain management has been docu mented to increase patient satisfaction and reduce both opioid use and the incidence of PONV. Combination of pain management in plastic surgery included patient-controlled analgesia intravenous (PCA-IV), patient-controlled epidural analgesia (PCEA), patient- controlled regional analgesia (PCRA), field block), continuous wound infusion system using pain pump and tumescent analgesia with local anesthetics. of peripheral nerve catheters, the protection of limbs, and plans for catheter release. In addition, it is necessary to inform the onset of pain in the operative limb after the loss of peripheral nerve block effects, the possibility of fluid leakage at the site of the catheter and its treatment, and possible complications such as nerve injury, local infection, toxicity of local anesthetics, and pulmonary disorders. One variation of the technique that recently attracted attention was the use of mandated/programmed intermit tent bolus (PIB) doses, using the theoretical basis that increased local anesthetic volumes administered at one time that could increase perineural spread compared to volume/dose equivalent given as a basal infusion. Continuous adductor channel block requires a higher local basal anesthetic rate than the femoral nerve block. One study showed that although local anesthetic agents were given at relatively high rates (8 ml/h), the spread of local anesthetics remained limited. Subsequent studies involving healthy volunteers showed 0.2% ropivacaine at 8 ml/h as basal dose or intermittent bolus doses hourly gave the same sensory percep tions and quadriceps strength. Similar results are also reported for interscalene, femoral, and popliteal/sciatic catheters. For these reasons, the use of recurrent bolus doses can be reduced, unless recent RCTs may demonstrate the benefit of analgesia after thoracotomy at relatively killers, such as paracetamol, NSAIDs, alpha-2-delta modulators (gabapentin and pregabalin), N-methyl-D-aspartate (NMDA) antagonists (ketamine and magnesium), alpha-2-agonists (clonidine and dexmedetomidine), TAP block, continuous wound infusion system using pain pump, and tumescent analgesia with local anesthetic.