From the Guidelines
After an abdominoplasty and breast enlargement, patients should be on opiates for less than a week, typically 3-7 days, with a goal to transition to non-opioid pain management as soon as possible. The management of postoperative pain should be personalized, taking into account the patient's surgical extent, individual pain tolerance, and medical history 1. According to the latest guidelines, a patient-centred approach should be used to limit the number of tablets and the duration of usual discharge opioid prescriptions, typically to less than a week 1.
Key Considerations
- The use of opioids should be guided by functional outcomes, rather than unidimensional pain scores alone 1.
- Multimodal analgesia should be optimized, and patients should be educated about the use of non-pharmacological and non-opioid analgesia to reduce the amount and duration of opioids required to restore function 1.
- Long-acting opioids should not be used routinely for acute postoperative pain, and immediate-release opioids are preferred in the management of postoperative pain when simple analgesics are insufficient to achieve the analgesic goals 1.
Recommendations for Pain Management
- Common opioid medications prescribed include oxycodone (5-10mg every 4-6 hours), hydrocodone/acetaminophen (5/325mg every 4-6 hours), or tramadol (50-100mg every 6 hours) 1.
- Patients should begin tapering opioid use as soon as pain becomes manageable, transitioning to scheduled acetaminophen (1000mg every 6 hours, not exceeding 4000mg daily) and NSAIDs like ibuprofen (400-600mg every 6 hours) if not contraindicated.
- Non-medication approaches such as cold therapy, proper positioning, and gentle movement also help reduce pain.
Importance of Early Transition to Non-Opioid Alternatives
Prolonged opioid use increases risks of dependence, constipation, and respiratory depression, which is why early transition to non-opioid alternatives is recommended 1. Each patient's pain experience varies, so pain management should be personalized with regular assessment by the surgical team.
From the Research
Postoperative Opiate Use for Abdominoplasty and Breast Enlargement
- The duration of postoperative opiate use for patients undergoing abdominoplasty and breast enlargement is not directly addressed in the provided studies.
- However, studies on similar surgical procedures provide some insight:
- A study on breast reduction surgery found that 50% of patients were using only nonnarcotic analgesia by postoperative day 3, and 80% of patients used a total of 10 tablets or less of narcotic pain medication 2.
- A study on tissue expander-based breast reconstruction found that patients used opioids for an average of 7.42 days after discharge, and the total number of oxycodone 5 mg equivalents consumed was 15.9 3.
- A study on outpatient breast surgery found that most patients (61.5%) had stopped taking opioids by postoperative day 5, and patients consumed a mean of 11.4 tablets following secondary breast reconstruction and a mean of 17.5 tablets after breast reduction 4.
Considerations for Combined Procedures
- Combining abdominoplasty with breast surgery does not appear to increase morbidity, according to a study that found no significant difference in morbidity rates between patients undergoing abdominoplasty alone and those undergoing abdominoplasty with combined breast surgery 5.
- Another study emphasizes the importance of considering the length of surgery and other factors to ensure the safe and successful execution of combined procedures like abdominoplasty and breast surgery 6.
Recommendations for Opiate Use
- Based on the available evidence, it is recommended that patients undergoing breast reconstruction or reduction be prescribed a limited number of opioid tablets, such as 10 oxycodone 5 mg tablets, and be counseled on the expected duration of outpatient opioid use 3.
- Physicians should be aware of the potential for overprescribing opioids and take steps to minimize narcotic use while ensuring adequate pain control 4.