An Analgesic Regimen for Opioid Reduction in Elective Plastic Surgery

A Randomized Prospective Study

Ashley Newman, B.S.; Steven P. Davison, M.D., D.D.S.

Plast Reconstr Surg. 2021;147(2):325e-330e.

Conclusions

The results of this prospective study demonstrate that multimodal enhanced recovery after surgery analgesic approaches for elective cosmetic surgery lead to improved pain control. Patients experienced decreased pain scores in the postanesthesia care unit and at discharge, and on average took fewer opioids in the postoperative period. The overprescribing of opioids in the postoperative period is a precursor to opioid abuse and results in an increase in the national opioid reservoir. Historical prescribing practices vastly overestimated the dose numbers required for elective cosmetic surgery procedures; with data provided in this article, enhanced recovery after surgery protocols may help to address overprescribing practices in elective cosmetic procedures.

1 2 3 4 5

Next Section

Table 1. Multimodal Enhanced Recovery after Surgery Protocol
Preoperative Medications	Intraoperative Medications	Postoperative Medications
1 g of acetaminophen by mouth	Standard anesthesia medications	650 mg of acetaminophen every 8 hr 300 mg of gabapentin every 8 hr
300 mg of gabapentin		5 mg of oxycodone every 4–6 hr for breakthrough pain only

Table 2. Traditional Opioid Protocol
Preoperative Medications	Intraoperative Medications	Postoperative Medications
None	Standard anesthesia medications	Percocet 5 mg/325 mg every 4–6 hr

Table 3. Demographics
Demographics	Standard	Multimodal	p
Mean age ± SD, yr	41.4 ± 13.9	39.2 ± 13.4	0.18
Mean BMI ± SD, kg/m²	24.6 ± 4.5	23.9 ± 4.0	0.17
Mean length of surgery, min	158 ± 73.3	163 ± 73.5	0.35

BMI, body mass index.

Table 4. Pain Scores*
Group	30-Min PACU Score	Discharge Score	Percentage Reduction in Pain Score from PACU Admission to Discharge
Multimodal analgesia	4.5 ± 2.1	2.3 ± 1.6	50.0
Standard analgesia	5.2 ± 2.5	3.1 ± 1.8	40.8

PACU, postanesthesia care unit.
*Scores are on a 0–10 Likert scale.

Table 5. Narcotics in the Postoperative Period*
Postoperative Period	Multimodal Analgesia	Standard Analgesia	Percentage Reduction	p
No. of pills taken	7.7 ± 5.3	11.9 ± 8.4	35.9	0.0007
No. of days pills needed	3.9 ± 2.2	4.7 ± 3.5	18.4	0.05

*These results do not include the amount of gabapentin taken in the multimodal group. All patients in the multimodal group took 300 mg of gabapentin every 8 hr for 3 days, according to study design.

Table 6. Patient Cost Based on Postoperative Analgesia Protocol
	No. of Tables	Cost
Multimodal analgesia
Oxycodone	30	$17.50
Zofran	6	$16.09
Gabapentin	9	$6.27
Acetaminophen	30	$8.53
Total		$48.39
Difference in cost		$8.58
Standard opioid analgesia
Percocet	3	$23.72
Zofran	6	$16.09
Total		$39.81