Pain Control in Augmentation Mammaplasty Using Indwelling Catheters in 687 Consecutive Patients: Data Analysis
Notice bibliographique
Résumé
BACKGROUND: Postoperative pain following augmentation mammaplasty can cause significant disability. In the authors' previously published prospective study of 644 consecutive augmentation mammaplasty patients, it was shown that the use of indwelling catheters for the postoperative instillation of bupivacaine is both safe and effective in postoperative pain management. OBJECTIVE: This study analyzes a large population of augmentation mammaplasty patients to not only compare the effectiveness of catheter control with systemic analgesics but also to delineate sites of pain and determine if any of a variety of factors influence postoperative pain. METHODS: Questionnaires were given to all patients to record the extent of pain reduction following the instillation of local anesthesia, patient preference for a variety of analgesics, and the locations of postoperative pain. Potential correlations to pain-including the number of children, age, handedness, preoperative fear, pain tolerance, and length of narcotic use-were investigated using statistical analysis. Operative aspects, such as the size of implants, use of asymmetrical implants, intraoperative expansion, duration of surgery, and sharp versus blunt dissection were also studied to determine if these factors influenced postoperative pain. RESULTS: Self-administration of bupivacaine the evening after surgery achieved pain reduction in 89% of patients. Patients gave high preference scores for the instillation of local anesthesia, comparable to rates achieved with the systemic narcotics Vicodin (Abbott Laboratories, Abbott Park, IL) and Percocet (Endo Pharmaceuticals, Chadds Ford, PA). Lower patient ratings were given to ibuprofen and methocarbamol. Patients identified multiple sites of postoperative pain, including the sternum, armpits, outer ribs, top of the breast (infraclavicular), interscapular region, and shoulders. Older patients experienced less pain. Patients who reported more pain, higher levels of fear, and sternal pain used narcotics for a longer period of time. Duration of surgery, blunt versus sharp dissection, and intraoperative expansion were not significantly related to pain. Combined implant size did not correlate with pain, though in the case of asymmetrical implants, greater pain (not statistically significant) on the larger side was reported. CONCLUSIONS: Postoperative pain following augmentation mammaplasty may be influenced by several factors, but these appear unrelated to implant size, specific operative techniques (blunt versus sharp dissection), or duration of surgery. Pain may involve not only the breasts, but also the sternum, sides of the chest, armpits, and infraclavicular and interscapular areas. The use of indwelling catheters for the instillation of a long-acting anesthetic is rated comparable in efficacy to the systemic narcotics Vicodin and Percocet. Sternal pain can be severe and may require narcotics for effective pain control.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».