Plastic Surgery Research Council

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Improved Patient Satisfaction After Reduction Mammaplasty with Dexamathasone-Bupivacaine Perineural Block
Alexander Neusner, MD1, Andrew Daigneau, BS2, Alexis Lo2, Richard Tyrell, MD1, Gaurav Trehan, MD1, Jon Livelsberger, DO1, Andrew Gassman, MD1.
1Temple University Hospital, Philadelphia, PA, USA, 2Lewis Katz School of Medicine of Temple University, Philadelphia, PA, USA.

Purpose: Reduction mammaplasty is generally considered among the plastic surgical procedures with the highest patient satisfaction. However, this procedure causes a significant amount of postoperative pain commonly requiring narcotic analgesia following discharge. Provision of effective pain control is an important aspect of patient satisfaction and is a key metric that is reported in many patient satisfaction surveys. Furthermore, pain management regimens that avoid the use of narcotics are desperately needed as the medical community tries to reverse the rise of opioid overuse. Regional blocks with bupivacaine are used routinely in practice during reduction mammaplasty. However, the effectiveness of block is limited by the 2-8 hour action of the medication. While Exparel® (bupivacaine liposome injection) is commercially available and provides a prolonged window of analgesia, it costs approximately 100 times as much as plain bupivacaine and so is prohibitively expensive for many institutions. Previous studies have examined the use of adding dexamethasone to bupivacaine in a perineural block and demonstrated a prolonged duration of analgesia. However this has never been studied in the plastic surgery literature. This randomized controlled trial compares patient satisfaction at follow-up when receiving a perineural block with bupivacaine alone versus a dexamethasone-bupivacaine mix prior to reduction mammaplasty. Methods: Patients undergoing bilateral reduction mammaplasty were offered enrollment in the study. Enrolled patients were randomized to either a control or experimental group. All enrolled patients received a perineural block preoperatively performed by an anesthesiologist. The control group received bupivacaine only while the treatment group received a combination of bupivacaine and dexamethasone. All patients received a standardized post-operative pain regimen. All were admitted for overnight observation. Following the first post-operative visit, patients were contacted by telephone and the SF-36 Medical Outcomes Survey was administered. 2 control patients and 4 experimental patients completed the survey. Results: Response rate for enrolled patients was 25%. Average scores in each outcome domain were compiled. Data was compared with a two-sided t test. A statistically significant improvement in post-operative pain was observed in the experimental group (p<0.01). Scores in each of the other six domains showed a possible slight trend in favor of the experimental group but none were significantly different (figure 1). Conclusion: Perineural block with dexamethasone and bupivacaine prior to reduction mammaplasty resulted in significant improvement in postoperative pain control compared to a block with bupivacaine alone. This study is ongoing and additional patient enrollment will allow for stronger data comparisons. Given the multidimensional nature of pain's effect on patient well-being, additional investigation may reveal improvements in other domains of patient medical outcomes using this modality.


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