Comparison of Postoperative Pain Control in Autologous Abdominal Free Flap versus Implant-Based Breast Reconstructions. Issue 2 (February 2015)

• Record Type: Journal Article
• Authors: Gassman, Andrew A.; Yoon, Alfred P.; Maxhimer, Justin B.; Sanchez, Ivan; Sethi, Harleen; Cheng, Kevin W.; Tseng, Charles Y.; Festekjian, Jaco H.; Da Lio, Andrew L.; Crisera, Chris A.
• Is Part Of: Plastic and reconstructive surgery. Volume 135:Issue 2(2015:Feb.)
• Publication Date: 2015-02
• Subjects: Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/PRS.0000000000000989
• Languages: English
• ISSNs: 0032-1052

Abstract

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). Conclusion: 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. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.