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PAIN AND PLASTIC SURGERY: HOW TO AVOID
COMPLICATIONS ON THE PATH TO PERFECTION
Xasanov Azim Mansurovich
Bukhara Innovative Education and Medical University.
assistant of the Department of clinical and pre-clinical sciences
Аnnotation.
Postoperative pain is a key issue in plastic surgery, especially
after major procedures. It may delay discharge and become chronic in 10–40% of
cases. Pain management relies on non-opioid drugs and regional analgesia;
opioids are used if needed.
Keywords:
plastic surgery, perioperative pain management, non-opioid
analgesics, regional analgesia
When selecting an analgesia regimen, especially in plastic surgery, it is
important to consider the etiopathogenetic features of postoperative pain. The
primary goal is to control dynamic pain to enable early patient mobilization. This
is best achieved with non-opioid analgesics and regional anesthesia. A preventive,
scheduled analgesic approach is more effective than patient-controlled, as-needed
administration.[1]
In major surgery, opioids remain the mainstay of postoperative analgesia,
despite evidence linking them to increased postoperative complications and
mortality. Overall, adverse effects occur in approximately 17% of patients.[2]
In plastic surgery, opioids are considered reserve drugs, used only when non-
opioid analgesia is insufficient or breakthrough pain occurs. Their use is often
associated with nausea and vomiting, which may lead to subcutaneous
hematomas, particularly after facelift procedures. Opioids also delay early
mobilization, increasing the risk of thromboembolic complications, which can be
especially severe in plastic surgery.[3]
In day-case surgery, opioid analgesics—except fentanyl—are generally
discouraged. Most plastic procedures are superficial, not involving muscle tissue,
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and effective pain control can typically be achieved with non-opioid analgesics
such as NSAIDs, paracetamol, and nefopam.[4]
Plastic surgeons have traditionally been cautious about NSAIDs due to
concerns about increased bleeding and hematoma formation. However, evidence-
based research does not support these concerns. A 2014 meta-analysis published
in
Plastic and Reconstructive Surgery
, involving 27 randomized controlled trials
and 2,314 patients receiving postoperative ketorolac, found no increased risk of
hematoma compared to those not treated with NSAIDs. [5]
Glucocorticoids have strong immunomodulatory and anti-inflammatory
properties, helping to reduce pain and inflammation. Dexamethasone also lowers
the incidence of postoperative nausea and vomiting (PONV). In 2014, the
American Society of Ambulatory Anesthesia recommended 4–8 mg IV
dexamethasone for PONV prevention. A meta-analysis of 45 studies showed that
intraoperative dexamethasone (1.25–20 mg) reduced pain intensity and opioid
requirements for up to 24 hours postoperatively.[6]
Сonclusions:
Effective postoperative pain management in plastic surgery
prioritizes early mobilization and minimizing complications. Non-opioid
analgesics and regional anesthesia form the foundation of current protocols, with
opioids reserved for breakthrough pain due to their association with adverse
effects, including nausea, vomiting, and delayed recovery. Despite concerns,
NSAIDs like ketorolac have been shown to be safe in terms of bleeding risk.
Additionally, dexamethasone offers both anti-inflammatory benefits and
significant reduction in postoperative nausea, pain intensity, and opioid use. A
preventive, scheduled analgesia strategy is preferred over patient-controlled
administration.
REFERENCES
1. Fortier J., Chung F., Su J. Unanticipated admission after ambulatory
surgery – a prospective study // Can. J. Anaesth. 1998. Vol. 45. P. 612–619.
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2. Pavlin D., Chen C., Penaloza D et al. Pain as a factor complicating
recovery and discharge after ambulatory surgery // Anesth. Analg. 2002. Vol. 95.
P. 627–634.
3. Pavlin D., Chen C., Penaloza D et al. A survey of pain and other symptoms
that affect the recovery process after discharge from an ambulatory surgery unit //
J. Clin. Anesth. 2004. Vol. 16. P. 200–206.
4. Brandi L., Frediani M., Oleggini M. Insulin resistance after surgery:
normalization by insulin treatment // Clin. Sci. 1990. Vol. 79. P. 443-450.
5. Page G., Blakely W., Ben-Eliyahu S. Evidence that postoperative pain is a
mediator of the tumor-promoting effects of surgery in rats // Pain. 2001. Vol. 90. P.
191–199.
6. Endara M., Masden D., Goldstein J., Gondek S. et al. The role of chronic
and perioperative glucose management in high-risk surgical closures: a case for
tighter glycemic control // Plast. Reconstr. Surg. 2013. Vol. 132. P. 996–1004.
