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===Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===
===Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===
A.   Conscious Sedation + Tumescent Technique <ref>{{Cite journal|last=Shestak|first=Kenneth C.|date=2004-05|title=The Outcome of Abdominoplasty Performed under Conscious Sedation: Six-Year Experience in 153 Consecutive Cases|url=http://dx.doi.org/10.1097/01.prs.0000118267.35908.01|journal=Plastic and Reconstructive Surgery|volume=113|issue=6|pages=1818–1819|doi=10.1097/01.prs.0000118267.35908.01|issn=0032-1052}}</ref><ref>{{Cite journal|last=Rosenberg|first=Michael H.|last2=Palaia|first2=David A.|last3=Bonanno|first3=Philip C.|date=2001-05|title=Abdominoplasty With Procedural Sedation and Analgesia|url=http://dx.doi.org/10.1097/00000637-200105000-00005|journal=Annals of Plastic Surgery|volume=46|issue=5|pages=485–487|doi=10.1097/00000637-200105000-00005|issn=0148-7043}}</ref><ref name=":1">{{Cite journal|last=Bagatin|first=Dinko|date=2019|title=Influence of Local Infiltration Analgesia on Postoperative Pain in Abdominoplasty Patients|url=http://dx.doi.org/10.20471/acc.2019.58.s1.03|journal=Acta Clinica Croatica|doi=10.20471/acc.2019.58.s1.03|issn=0353-9466}}</ref>


·      Appears to be safe
* Conscious Sedation + Tumescent Technique <ref>{{Cite journal|last=Shestak|first=Kenneth C.|date=2004-05|title=The Outcome of Abdominoplasty Performed under Conscious Sedation: Six-Year Experience in 153 Consecutive Cases|url=http://dx.doi.org/10.1097/01.prs.0000118267.35908.01|journal=Plastic and Reconstructive Surgery|volume=113|issue=6|pages=1818–1819|doi=10.1097/01.prs.0000118267.35908.01|issn=0032-1052}}</ref><ref>{{Cite journal|last=Rosenberg|first=Michael H.|last2=Palaia|first2=David A.|last3=Bonanno|first3=Philip C.|date=2001-05|title=Abdominoplasty With Procedural Sedation and Analgesia|url=http://dx.doi.org/10.1097/00000637-200105000-00005|journal=Annals of Plastic Surgery|volume=46|issue=5|pages=485–487|doi=10.1097/00000637-200105000-00005|issn=0148-7043}}</ref><ref name=":1">{{Cite journal|last=Bagatin|first=Dinko|date=2019|title=Influence of Local Infiltration Analgesia on Postoperative Pain in Abdominoplasty Patients|url=http://dx.doi.org/10.20471/acc.2019.58.s1.03|journal=Acta Clinica Croatica|doi=10.20471/acc.2019.58.s1.03|issn=0353-9466}}</ref>
 
** Appears to be safe
·      May have a lower risk of DVT compare to general anesthesia
** May have a lower risk of DVT compare to general anesthesia
 
** Tumescent local infiltration anesthesia also helps with post-op pain <ref name=":1" /><ref>{{Cite journal|last=Kakagia|first=Despoina D.|last2=Fotiadis|first2=Spartakos|last3=Tripsiannis|first3=Gregory|last4=Tsoutsos|first4=Dimosthenis|date=2007-01-04|title=Postoperative Analgesic Effect of Locally Infiltrated Levobupivacaine in Fleur-de-Lys Abdominoplasty|url=http://dx.doi.org/10.1007/s00266-006-0187-4|journal=Aesthetic Plastic Surgery|volume=31|issue=2|pages=128–132|doi=10.1007/s00266-006-0187-4|issn=0364-216X}}</ref>
·      Tumescent local infiltration anesthesia also helps with post-op pain <ref name=":1" /><ref>{{Cite journal|last=Kakagia|first=Despoina D.|last2=Fotiadis|first2=Spartakos|last3=Tripsiannis|first3=Gregory|last4=Tsoutsos|first4=Dimosthenis|date=2007-01-04|title=Postoperative Analgesic Effect of Locally Infiltrated Levobupivacaine in Fleur-de-Lys Abdominoplasty|url=http://dx.doi.org/10.1007/s00266-006-0187-4|journal=Aesthetic Plastic Surgery|volume=31|issue=2|pages=128–132|doi=10.1007/s00266-006-0187-4|issn=0364-216X}}</ref>
** Increased risk of respiratory depression, usually resolves with simple stimulation
 
** Increased fentanyl use is associated with longer stay in recovery unit <ref>{{Cite journal|last=Pechter|first=Edward A.|date=2000-04|title=The Clinical Outcome of Abdominoplasty Performed Under Conscious Sedation: Increased Use of Fentanyl Correlated with Longer Stay in Outpatient Unit|url=http://dx.doi.org/10.1097/00006534-200004040-00074|journal=Plastic &amp; Reconstructive Surgery|volume=105|issue=4|pages=1577|doi=10.1097/00006534-200004040-00074|issn=0032-1052}}</ref>
·      Increased risk of respiratory depression, usually resolves with simple stimulation
* Neuraxial Techniques
 
** Useful when the patient has higher risk cardiac complications, respiratory complications, malignant hyperthermia (HM), and rhabdomyolysis from anesthesia <ref name=":2">{{Cite journal|last=Leal|first=Plinio da Cunha|last2=Lima|first2=Wildney Leite|last3=Oliveira|first3=Eduardo José Silva Gomes de|last4=Oliveira|first4=Caio Márcio Barros de|last5=Gomes|first5=Lyvia Maria Rodrigues de Sousa|last6=Servin|first6=Elizabeth Teixeira Noguera|last7=Moura|first7=Ed Carlos Rey|date=2021-04|title=Combined spinal-epidural anesthesia for abdominoplasty and liposuction in Limb-Girdle Muscular Dystrophy: case report|url=http://dx.doi.org/10.1016/j.bjane.2021.02.046|journal=Brazilian Journal of Anesthesiology (English Edition)|doi=10.1016/j.bjane.2021.02.046|issn=0104-0014}}</ref>.
·      Increased fentanyl use is associated with longer stay in recovery unit <ref>{{Cite journal|last=Pechter|first=Edward A.|date=2000-04|title=The Clinical Outcome of Abdominoplasty Performed Under Conscious Sedation: Increased Use of Fentanyl Correlated with Longer Stay in Outpatient Unit|url=http://dx.doi.org/10.1097/00006534-200004040-00074|journal=Plastic &amp; Reconstructive Surgery|volume=105|issue=4|pages=1577|doi=10.1097/00006534-200004040-00074|issn=0032-1052}}</ref>
** Spinal, epidural or combined spinal-epidural anesthesia can be used <ref name=":2" /><ref>{{Cite journal|last=Kodeih|first=Mohammad G.|last2=Al-Alami|first2=Achir A.|last3=Atiyeh|first3=Bechara S.|last4=Kanazi|first4=Ghassan E.|date=2009-03|title=Combined Spinal Epidural Anesthesia in an Asthmatic Patient Undergoing Abdominoplasty|url=http://dx.doi.org/10.1097/prs.0b013e31819a35c9|journal=Plastic and Reconstructive Surgery|volume=123|issue=3|pages=118e–120e|doi=10.1097/prs.0b013e31819a35c9|issn=0032-1052}}</ref><ref>{{Cite journal|last=Metry|first=AymanAnis|last2=Nakhla|first2=GeorgeM|last3=Wahba|first3=WahbaZ|last4=Wahba|first4=RamiM|last5=Kamel|first5=IbrahimH|date=2019|title=Abdominoplasty under spinal anesthesia: A feasibility study|url=http://dx.doi.org/10.4103/aer.aer_69_19|journal=Anesthesia: Essays and Researches|volume=13|issue=2|pages=243|doi=10.4103/aer.aer_69_19|issn=0259-1162}}</ref>
 
** Safely provide adequate pain control in high risk GA patients
B.    Neuraxial Techniques: useful when the patient has higher risk cardiac complications, respiratory complications, malignant hyperthermia (HM), and rhabdomyolysis from anesthesia <ref name=":2">{{Cite journal|last=Leal|first=Plinio da Cunha|last2=Lima|first2=Wildney Leite|last3=Oliveira|first3=Eduardo José Silva Gomes de|last4=Oliveira|first4=Caio Márcio Barros de|last5=Gomes|first5=Lyvia Maria Rodrigues de Sousa|last6=Servin|first6=Elizabeth Teixeira Noguera|last7=Moura|first7=Ed Carlos Rey|date=2021-04|title=Combined spinal-epidural anesthesia for abdominoplasty and liposuction in Limb-Girdle Muscular Dystrophy: case report|url=http://dx.doi.org/10.1016/j.bjane.2021.02.046|journal=Brazilian Journal of Anesthesiology (English Edition)|doi=10.1016/j.bjane.2021.02.046|issn=0104-0014}}</ref>.
** Decreased needs for post-op opiates
 
** Patients able to ambulate in shorter amount of time (better DVT prevention)
o   Combined spinal-epidural anesthesia <ref name=":2" /><ref>{{Cite journal|last=Kodeih|first=Mohammad G.|last2=Al-Alami|first2=Achir A.|last3=Atiyeh|first3=Bechara S.|last4=Kanazi|first4=Ghassan E.|date=2009-03|title=Combined Spinal Epidural Anesthesia in an Asthmatic Patient Undergoing Abdominoplasty|url=http://dx.doi.org/10.1097/prs.0b013e31819a35c9|journal=Plastic and Reconstructive Surgery|volume=123|issue=3|pages=118e–120e|doi=10.1097/prs.0b013e31819a35c9|issn=0032-1052}}</ref>
* Regional techniques
 
** Decreased time in recovery room, postoperative narcotics, postoperative nausea and vomiting<ref>{{Cite journal|last=Gutowski|first=K.A.|date=2011-01|title=Outpatient Abdominoplasty Facilitated by Rib Blocks|url=http://dx.doi.org/10.1016/s1535-1513(09)79493-7|journal=Yearbook of Plastic and Aesthetic Surgery|volume=2011|pages=158–159|doi=10.1016/s1535-1513(09)79493-7|issn=1535-1513}}</ref>
·      Safely provide adequate pain control in high risk GA patients
** Quadratus lumborum (QL) block
 
*** Inconsistent results with regard to sparing of post-op opioids <ref name=":3">{{Cite web|last=Efsun Ozgunay|first=Seyda|last2=caglayan|first2=Umit|last3=Yilmaz|first3=Canan|date=2018-05-16|title=09 / Comparison of ultrasound guided transversus abdominis plane block and quadratus lumborum block for postoperative pain in cesarean section: A prospective, randomized-controlled study.|url=http://dx.doi.org/10.26226/morressier.5aeb0ac707b0d6001a79a2a8|access-date=2023-09-11|website=dx.doi.org}}</ref><ref>{{Cite journal|last=Bjelland|first=Thor W.|last2=Yates|first2=Thomas G.R.|last3=Fagerland|first3=Morten W.|last4=Frøyen|first4=Jan K.|last5=Lysebråten|first5=Karl R.|last6=Spreng|first6=Ulrich J.|date=2019-05-21|title=Quadratus lumborum block for postoperative analgesia after full abdominoplasty: a randomized controlled trial|url=http://dx.doi.org/10.1515/sjpain-2019-0013|journal=Scandinavian Journal of Pain|volume=19|issue=4|pages=671–678|doi=10.1515/sjpain-2019-0013|issn=1877-8879}}</ref>
o   Spinal anesthesia <ref>{{Cite journal|last=Metry|first=AymanAnis|last2=Nakhla|first2=GeorgeM|last3=Wahba|first3=WahbaZ|last4=Wahba|first4=RamiM|last5=Kamel|first5=IbrahimH|date=2019|title=Abdominoplasty under spinal anesthesia: A feasibility study|url=http://dx.doi.org/10.4103/aer.aer_69_19|journal=Anesthesia: Essays and Researches|volume=13|issue=2|pages=243|doi=10.4103/aer.aer_69_19|issn=0259-1162}}</ref>
*** Better pain control <ref name=":3" />
 
** Transversus abdominis plane (TAP) block <ref>{{Cite journal|last=Oppenheimer|first=Adam J.|last2=Fiala|first2=Thomas G.S.|last3=Oppenheimer|first3=Daniel C.|date=2016-11|title=Direct Transversus Abdominis Plane Blocks With Exparel During Abdominoplasty|url=http://dx.doi.org/10.1097/sap.0000000000000659|journal=Annals of Plastic Surgery|volume=77|issue=5|pages=499–500|doi=10.1097/sap.0000000000000659|issn=0148-7043}}</ref><ref>{{Cite journal|last=Fiala|first=Thomas|date=2015-01-01|title=Tranversus Abdominis Plane Block During Abdominoplasty to Improve Postoperative Patient Comfort|url=http://dx.doi.org/10.1093/asj/sju019|journal=Aesthetic Surgery Journal|volume=35|issue=1|pages=72–80|doi=10.1093/asj/sju019|issn=1527-330X}}</ref><ref>{{Cite journal|last=Sforza|first=Marcos|last2=Andjelkov|first2=Katarina|last3=Zaccheddu|first3=Renato|last4=Nagi|first4=Hussein|last5=Colic|first5=Miodrag|date=2011-08|title=Transversus Abdominis Plane Block Anesthesia in Abdominoplasties|url=http://dx.doi.org/10.1097/prs.0b013e31821e6f51|journal=Plastic and Reconstructive Surgery|volume=128|issue=2|pages=529–535|doi=10.1097/prs.0b013e31821e6f51|issn=0032-1052}}</ref><ref>{{Cite journal|last=Alotaibi|first=Nawaf Naif|last2=Ahmad|first2=Tawheed|last3=Rabah|first3=Sari Monzer|last4=Hamza|first4=Aljohara Mohmoud|last5=Mohammad Tafazul|first5=Sheikh|date=2021-01-05|title=Evaluation of transversus abdominis plane (TAP) block in lipoabdominoplasty surgical procedure: a comparative study|url=http://dx.doi.org/10.1080/2000656x.2020.1856676|journal=Journal of Plastic Surgery and Hand Surgery|volume=55|issue=4|pages=216–219|doi=10.1080/2000656x.2020.1856676|issn=2000-656X}}</ref><ref name=":4">{{Cite journal|last=Gravante|first=Gianpiero|last2=Castrì|first2=Francesca|last3=Araco|first3=Francesco|last4=Araco|first4=Antonino|date=2010-06-02|title=A Comparative Study of the Transversus Abdominis Plane (TAP) Block Efficacy on Post-bariatric vs Aesthetic Abdominoplasty with Flank Liposuction|url=http://dx.doi.org/10.1007/s11695-010-0203-2|journal=Obesity Surgery|volume=21|issue=3|pages=278–282|doi=10.1007/s11695-010-0203-2|issn=0960-8923}}</ref>
·      May consider when the surgery is expected to be <3h
*** Decreased postoperative opioid use
 
*** Early ambulation
·      Decreased needs for post-op opiates
*** Possibly less effective in post-bariatric surgery patient due to more traumatic operation <ref name=":4" />
 
** Erector spinae plane block <ref>{{Cite journal|last=Perez|first=Mauricio E.|last2=Hoyos|first2=Alfredo E.|date=2020-10-08|title=Invited Discussion on: Evaluation of the Effect of Erector Spinae Plane Block in Patients Undergoing Belt Lipectomy Surgery|url=http://dx.doi.org/10.1007/s00266-020-01944-3|journal=Aesthetic Plastic Surgery|volume=44|issue=6|pages=2143–2146|doi=10.1007/s00266-020-01944-3|issn=0364-216X}}</ref>
·      Patients able to ambulate in shorter amount of time (better DVT prevention)
*** Decreased postoperative opioid use
 
*** Early ambulation
o   Epidural anesthesia <ref>{{Cite journal|last=Gutowski|first=K.A.|date=2013-01|title=Epidural Anesthesia as a Thromboembolic Prophylaxis Modality in Plastic Surgery|url=http://dx.doi.org/10.1016/j.yprs.2012.07.012|journal=Yearbook of Plastic and Aesthetic Surgery|volume=2013|pages=74|doi=10.1016/j.yprs.2012.07.012|issn=1535-1513}}</ref>
** Combined intercostal and pararectus blocks <ref>{{Cite journal|last=Feng|first=Lu-Jean|date=2010-11|title=Painless Abdominoplasty: The Efficacy of Combined Intercostal and Pararectus Blocks in Reducing Postoperative Pain and Recovery Time|url=http://dx.doi.org/10.1097/prs.0b013e3181ef8fe5|journal=Plastic and Reconstructive Surgery|volume=126|issue=5|pages=1723–1732|doi=10.1097/prs.0b013e3181ef8fe5|issn=0032-1052}}</ref>
 
*** Decreased postoperative opioid use
·      Appears to be feasible
*** Decreased time in recovery room
 
** Others
·      May decrease risk of DVT
*** Limited studies have been completed for paravertebral, rectus sheet, iliohypogastric/ilioinguinal <ref>{{Cite journal|last=Rudkin|first=Glenda E.|last2=Gardiner|first2=Sarah E.|last3=Cooter|first3=Rodney D.|date=2008-02|title=Bilateral thoracic paravertebral block for abdominoplasty|url=http://dx.doi.org/10.1016/j.jclinane.2007.06.020|journal=Journal of Clinical Anesthesia|volume=20|issue=1|pages=54–56|doi=10.1016/j.jclinane.2007.06.020|issn=0952-8180}}</ref><ref>{{Cite journal|last=Seretis|first=Konstantinos|last2=Bounas|first2=Nikolaos|date=2022-12-06|title=The Efficacy of Different Nerve Blocks on Postoperative Pain and Sequelae in Patients Undergoing Abdominoplasty: A Network Meta-Analysis|url=http://dx.doi.org/10.1093/asj/sjac319|journal=Aesthetic Surgery Journal|volume=43|issue=5|pages=NP325–NP336|doi=10.1093/asj/sjac319|issn=1090-820X}}</ref> blocks, can possibly be used/helpful
 
C.    Others
 
o   Rib block + IV sedation <ref>{{Cite journal|last=Gutowski|first=K.A.|date=2011-01|title=Outpatient Abdominoplasty Facilitated by Rib Blocks|url=http://dx.doi.org/10.1016/s1535-1513(09)79493-7|journal=Yearbook of Plastic and Aesthetic Surgery|volume=2011|pages=158–159|doi=10.1016/s1535-1513(09)79493-7|issn=1535-1513}}</ref>
 
·      Decreased time in recovery room, postoperative narcotics, postoperative nausea and vomiting


==Intraoperative management==
==Intraoperative management==


===Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. -->===
===Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. -->===
Standard ASA monitors
 
* Standard ASA monitors


===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->===
===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->===
Standard induction, consider video laryngoscopy if concern for difficult direct laryngoscopy
 
* Standard induction


===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->===
===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->===
Supine


Secure arms / Check IV
* Supine


===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->===
===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->===
Standard maintenance


Maintain normothermia
* Standard maintenance
* Maintain normothermia


===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->===
===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->===
Smooth emergence, minimize tension on the suture line


PONV prophylaxis
* Smooth emergence to minimize tension on the suture line
* PONV prophylaxis


==Postoperative management==
==Postoperative management==
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PACU
PACU


·      Early ambulation is mandatory
* Early ambulation is mandatory
 
* Drain maintenance
·      Drain maintenance
* Rest in flexed position (>30 degrees head of bed elevation)
 
* Abdominal binder
·      Rest in flexed position (>30 degrees head of bed elevation)
 
·      Abdominal binder


===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->===
===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->===
IV narcotics with possible regional anesthesia techniques below.
Regional Anesthesia Techniques
·      Quadratus lumborum (QL) block
                       I.         Inconsistent results with regard to sparing of post-op opiates <ref name=":3">{{Cite web|last=Efsun Ozgunay|first=Seyda|last2=caglayan|first2=Umit|last3=Yilmaz|first3=Canan|date=2018-05-16|title=09 / Comparison of ultrasound guided transversus abdominis plane block and quadratus lumborum block for postoperative pain in cesarean section: A prospective, randomized-controlled study.|url=http://dx.doi.org/10.26226/morressier.5aeb0ac707b0d6001a79a2a8|access-date=2023-09-11|website=dx.doi.org}}</ref><ref>{{Cite journal|last=Bjelland|first=Thor W.|last2=Yates|first2=Thomas G.R.|last3=Fagerland|first3=Morten W.|last4=Frøyen|first4=Jan K.|last5=Lysebråten|first5=Karl R.|last6=Spreng|first6=Ulrich J.|date=2019-05-21|title=Quadratus lumborum block for postoperative analgesia after full abdominoplasty: a randomized controlled trial|url=http://dx.doi.org/10.1515/sjpain-2019-0013|journal=Scandinavian Journal of Pain|volume=19|issue=4|pages=671–678|doi=10.1515/sjpain-2019-0013|issn=1877-8879}}</ref>


                     II.         Better pain control <ref name=":3" />
* IV narcotics with possible regional anesthesia techniques as described above
 
·      Transversus abdominis plane (TAP) block <ref>{{Cite journal|last=Oppenheimer|first=Adam J.|last2=Fiala|first2=Thomas G.S.|last3=Oppenheimer|first3=Daniel C.|date=2016-11|title=Direct Transversus Abdominis Plane Blocks With Exparel During Abdominoplasty|url=http://dx.doi.org/10.1097/sap.0000000000000659|journal=Annals of Plastic Surgery|volume=77|issue=5|pages=499–500|doi=10.1097/sap.0000000000000659|issn=0148-7043}}</ref><ref>{{Cite journal|last=Fiala|first=Thomas|date=2015-01-01|title=Tranversus Abdominis Plane Block During Abdominoplasty to Improve Postoperative Patient Comfort|url=http://dx.doi.org/10.1093/asj/sju019|journal=Aesthetic Surgery Journal|volume=35|issue=1|pages=72–80|doi=10.1093/asj/sju019|issn=1527-330X}}</ref><ref>{{Cite journal|last=Sforza|first=Marcos|last2=Andjelkov|first2=Katarina|last3=Zaccheddu|first3=Renato|last4=Nagi|first4=Hussein|last5=Colic|first5=Miodrag|date=2011-08|title=Transversus Abdominis Plane Block Anesthesia in Abdominoplasties|url=http://dx.doi.org/10.1097/prs.0b013e31821e6f51|journal=Plastic and Reconstructive Surgery|volume=128|issue=2|pages=529–535|doi=10.1097/prs.0b013e31821e6f51|issn=0032-1052}}</ref><ref>{{Cite journal|last=Alotaibi|first=Nawaf Naif|last2=Ahmad|first2=Tawheed|last3=Rabah|first3=Sari Monzer|last4=Hamza|first4=Aljohara Mohmoud|last5=Mohammad Tafazul|first5=Sheikh|date=2021-01-05|title=Evaluation of transversus abdominis plane (TAP) block in lipoabdominoplasty surgical procedure: a comparative study|url=http://dx.doi.org/10.1080/2000656x.2020.1856676|journal=Journal of Plastic Surgery and Hand Surgery|volume=55|issue=4|pages=216–219|doi=10.1080/2000656x.2020.1856676|issn=2000-656X}}</ref><ref name=":4">{{Cite journal|last=Gravante|first=Gianpiero|last2=Castrì|first2=Francesca|last3=Araco|first3=Francesco|last4=Araco|first4=Antonino|date=2010-06-02|title=A Comparative Study of the Transversus Abdominis Plane (TAP) Block Efficacy on Post-bariatric vs Aesthetic Abdominoplasty with Flank Liposuction|url=http://dx.doi.org/10.1007/s11695-010-0203-2|journal=Obesity Surgery|volume=21|issue=3|pages=278–282|doi=10.1007/s11695-010-0203-2|issn=0960-8923}}</ref>
 
                       I.         Decrease needs for post-op opiates
 
                     II.         Early ambulation
 
                   III.         Possibly less effective in post-bariatric surgery patient due to more traumatic operation <ref name=":4" />
 
·      Erector spinae plane block <ref>{{Cite journal|last=Perez|first=Mauricio E.|last2=Hoyos|first2=Alfredo E.|date=2020-10-08|title=Invited Discussion on: Evaluation of the Effect of Erector Spinae Plane Block in Patients Undergoing Belt Lipectomy Surgery|url=http://dx.doi.org/10.1007/s00266-020-01944-3|journal=Aesthetic Plastic Surgery|volume=44|issue=6|pages=2143–2146|doi=10.1007/s00266-020-01944-3|issn=0364-216X}}</ref>
 
                       I.         Decrease needs for post-op opiates
 
                     II.         Early ambulation
 
·      Combined intercostal and pararectus blocks <ref>{{Cite journal|last=Feng|first=Lu-Jean|date=2010-11|title=Painless Abdominoplasty: The Efficacy of Combined Intercostal and Pararectus Blocks in Reducing Postoperative Pain and Recovery Time|url=http://dx.doi.org/10.1097/prs.0b013e3181ef8fe5|journal=Plastic and Reconstructive Surgery|volume=126|issue=5|pages=1723–1732|doi=10.1097/prs.0b013e3181ef8fe5|issn=0032-1052}}</ref>
 
                       I.         Decreased needs for post-op opiates
 
                     II.         Decreased time in recovery room
 
·      Others: limited studies have been completed in paravertebral, rectus sheet, iliohypogastric/ilioinguinal <ref>{{Cite journal|last=Rudkin|first=Glenda E.|last2=Gardiner|first2=Sarah E.|last3=Cooter|first3=Rodney D.|date=2008-02|title=Bilateral thoracic paravertebral block for abdominoplasty|url=http://dx.doi.org/10.1016/j.jclinane.2007.06.020|journal=Journal of Clinical Anesthesia|volume=20|issue=1|pages=54–56|doi=10.1016/j.jclinane.2007.06.020|issn=0952-8180}}</ref><ref>{{Cite journal|last=Seretis|first=Konstantinos|last2=Bounas|first2=Nikolaos|date=2022-12-06|title=The Efficacy of Different Nerve Blocks on Postoperative Pain and Sequelae in Patients Undergoing Abdominoplasty: A Network Meta-Analysis|url=http://dx.doi.org/10.1093/asj/sjac319|journal=Aesthetic Surgery Journal|volume=43|issue=5|pages=NP325–NP336|doi=10.1093/asj/sjac319|issn=1090-820X}}</ref> blocks, can possibly be used/helpful


===Potential major complications <ref name=":0" /><!-- List and/or describe any potential postoperative complications for this case. -->===
===Potential major complications <ref name=":0" /><!-- List and/or describe any potential postoperative complications for this case. -->===
DVT/PE, respiratory compromise, abdominal compartment syndrome, systemic infections
DVT/PE, respiratory compromise, abdominal compartment syndrome, systemic infections
==Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). -->==
{| class="wikitable wikitable-horizontal-scroll"
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!Variant 1
!Variant 2
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|Indications
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|Position
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|Surgical time
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|EBL
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==References==
==References==

Latest revision as of 14:35, 12 September 2023

Abdominoplasty
Anesthesia type

General Anesthesia (most common), Conscious Sedation with Tumescent Technique/Neuraxial Techniques also feasible

Airway

ETT (most common)

Lines and access

PIV

Monitors

Standard

Primary anesthetic considerations
Preoperative

Potential difficult airway, cardiac/pulm conditions, bleeding/clotting

Intraoperative

IV prophylactic antibiotic, thrombosis prophylaxis, hypothermia precaution

Postoperative

DVT/PE, respiratory compromise, abdominal compartment syndrome

Article quality
Editor rating
Unrated
User likes
0

Abdominoplasty is a surgery done to remove excess fat, skin, and repair rectus diastasis to help improve health and appearance. This can occur after a person undergoes massive weight loss. Depending on physical examination findings, several procedures can be done, including mini-abdominoplasty, traditional abdominoplasty, circumferential, high lateral tension, Fleur-de-lis, and reverse abdominoplasty[1].

Overview

Indications

Excess fat, skin, and abdominal wall weakness [1].

Preoperative management

Patient evaluation [1]

System Considerations
Airway obesity
Cardiovascular/Pulmonary cardiac conditions, OSA
Gastrointestinal IBS, constipation, previous abdominal surgeries, abdominal scarring
Genitourinary C-sections, desire for future pregnancy, abdominal scarring
Hematologic bleeding/clotting disorders, history of bleeding/clotting
Endocrine T2DM, hormone use
Other smoking status, A1C

Operating room setup [1]

IV antibiotics 30-59 min before the incision

SCDs (DVT prophylaxis)

Avoid intraoperative hypothermia

Patient preparation and premedication

IV antibiotics 30-59 min before the incision

Regional and neuraxial techniques

  • Conscious Sedation + Tumescent Technique [2][3][4]
    • Appears to be safe
    • May have a lower risk of DVT compare to general anesthesia
    • Tumescent local infiltration anesthesia also helps with post-op pain [4][5]
    • Increased risk of respiratory depression, usually resolves with simple stimulation
    • Increased fentanyl use is associated with longer stay in recovery unit [6]
  • Neuraxial Techniques
    • Useful when the patient has higher risk cardiac complications, respiratory complications, malignant hyperthermia (HM), and rhabdomyolysis from anesthesia [7].
    • Spinal, epidural or combined spinal-epidural anesthesia can be used [7][8][9]
    • Safely provide adequate pain control in high risk GA patients
    • Decreased needs for post-op opiates
    • Patients able to ambulate in shorter amount of time (better DVT prevention)
  • Regional techniques
    • Decreased time in recovery room, postoperative narcotics, postoperative nausea and vomiting[10]
    • Quadratus lumborum (QL) block
      • Inconsistent results with regard to sparing of post-op opioids [11][12]
      • Better pain control [11]
    • Transversus abdominis plane (TAP) block [13][14][15][16][17]
      • Decreased postoperative opioid use
      • Early ambulation
      • Possibly less effective in post-bariatric surgery patient due to more traumatic operation [17]
    • Erector spinae plane block [18]
      • Decreased postoperative opioid use
      • Early ambulation
    • Combined intercostal and pararectus blocks [19]
      • Decreased postoperative opioid use
      • Decreased time in recovery room
    • Others
      • Limited studies have been completed for paravertebral, rectus sheet, iliohypogastric/ilioinguinal [20][21] blocks, can possibly be used/helpful

Intraoperative management

Monitoring and access

  • Standard ASA monitors

Induction and airway management

  • Standard induction

Positioning

  • Supine

Maintenance and surgical considerations

  • Standard maintenance
  • Maintain normothermia

Emergence

  • Smooth emergence to minimize tension on the suture line
  • PONV prophylaxis

Postoperative management

Disposition [1]

PACU

  • Early ambulation is mandatory
  • Drain maintenance
  • Rest in flexed position (>30 degrees head of bed elevation)
  • Abdominal binder

Pain management

  • IV narcotics with possible regional anesthesia techniques as described above

Potential major complications [1]

DVT/PE, respiratory compromise, abdominal compartment syndrome, systemic infections

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Janis, Jeffrey E.; Bunch, Brenda; Tomasikiewicz, Amanda; Taylor, Sarah; Gentry, Jennifer; Chambers, Graeme, eds. (2023). Essentials of plastic surgery (Third edition ed.). New York Stuttgart Delhi Rio de Janeiro: Thieme. ISBN 978-1-62623-847-3. |edition= has extra text (help)
  2. Shestak, Kenneth C. (2004-05). "The Outcome of Abdominoplasty Performed under Conscious Sedation: Six-Year Experience in 153 Consecutive Cases". Plastic and Reconstructive Surgery. 113 (6): 1818–1819. doi:10.1097/01.prs.0000118267.35908.01. ISSN 0032-1052. Check date values in: |date= (help)
  3. Rosenberg, Michael H.; Palaia, David A.; Bonanno, Philip C. (2001-05). "Abdominoplasty With Procedural Sedation and Analgesia". Annals of Plastic Surgery. 46 (5): 485–487. doi:10.1097/00000637-200105000-00005. ISSN 0148-7043. Check date values in: |date= (help)
  4. 4.0 4.1 Bagatin, Dinko (2019). "Influence of Local Infiltration Analgesia on Postoperative Pain in Abdominoplasty Patients". Acta Clinica Croatica. doi:10.20471/acc.2019.58.s1.03. ISSN 0353-9466.
  5. Kakagia, Despoina D.; Fotiadis, Spartakos; Tripsiannis, Gregory; Tsoutsos, Dimosthenis (2007-01-04). "Postoperative Analgesic Effect of Locally Infiltrated Levobupivacaine in Fleur-de-Lys Abdominoplasty". Aesthetic Plastic Surgery. 31 (2): 128–132. doi:10.1007/s00266-006-0187-4. ISSN 0364-216X.
  6. Pechter, Edward A. (2000-04). "The Clinical Outcome of Abdominoplasty Performed Under Conscious Sedation: Increased Use of Fentanyl Correlated with Longer Stay in Outpatient Unit". Plastic & Reconstructive Surgery. 105 (4): 1577. doi:10.1097/00006534-200004040-00074. ISSN 0032-1052. Check date values in: |date= (help)
  7. 7.0 7.1 Leal, Plinio da Cunha; Lima, Wildney Leite; Oliveira, Eduardo José Silva Gomes de; Oliveira, Caio Márcio Barros de; Gomes, Lyvia Maria Rodrigues de Sousa; Servin, Elizabeth Teixeira Noguera; Moura, Ed Carlos Rey (2021-04). "Combined spinal-epidural anesthesia for abdominoplasty and liposuction in Limb-Girdle Muscular Dystrophy: case report". Brazilian Journal of Anesthesiology (English Edition). doi:10.1016/j.bjane.2021.02.046. ISSN 0104-0014. Check date values in: |date= (help)
  8. Kodeih, Mohammad G.; Al-Alami, Achir A.; Atiyeh, Bechara S.; Kanazi, Ghassan E. (2009-03). "Combined Spinal Epidural Anesthesia in an Asthmatic Patient Undergoing Abdominoplasty". Plastic and Reconstructive Surgery. 123 (3): 118e–120e. doi:10.1097/prs.0b013e31819a35c9. ISSN 0032-1052. Check date values in: |date= (help)
  9. Metry, AymanAnis; Nakhla, GeorgeM; Wahba, WahbaZ; Wahba, RamiM; Kamel, IbrahimH (2019). "Abdominoplasty under spinal anesthesia: A feasibility study". Anesthesia: Essays and Researches. 13 (2): 243. doi:10.4103/aer.aer_69_19. ISSN 0259-1162.
  10. Gutowski, K.A. (2011-01). "Outpatient Abdominoplasty Facilitated by Rib Blocks". Yearbook of Plastic and Aesthetic Surgery. 2011: 158–159. doi:10.1016/s1535-1513(09)79493-7. ISSN 1535-1513. Check date values in: |date= (help)
  11. 11.0 11.1 Efsun Ozgunay, Seyda; caglayan, Umit; Yilmaz, Canan (2018-05-16). "09 / Comparison of ultrasound guided transversus abdominis plane block and quadratus lumborum block for postoperative pain in cesarean section: A prospective, randomized-controlled study". dx.doi.org. Retrieved 2023-09-11.
  12. Bjelland, Thor W.; Yates, Thomas G.R.; Fagerland, Morten W.; Frøyen, Jan K.; Lysebråten, Karl R.; Spreng, Ulrich J. (2019-05-21). "Quadratus lumborum block for postoperative analgesia after full abdominoplasty: a randomized controlled trial". Scandinavian Journal of Pain. 19 (4): 671–678. doi:10.1515/sjpain-2019-0013. ISSN 1877-8879.
  13. Oppenheimer, Adam J.; Fiala, Thomas G.S.; Oppenheimer, Daniel C. (2016-11). "Direct Transversus Abdominis Plane Blocks With Exparel During Abdominoplasty". Annals of Plastic Surgery. 77 (5): 499–500. doi:10.1097/sap.0000000000000659. ISSN 0148-7043. Check date values in: |date= (help)
  14. Fiala, Thomas (2015-01-01). "Tranversus Abdominis Plane Block During Abdominoplasty to Improve Postoperative Patient Comfort". Aesthetic Surgery Journal. 35 (1): 72–80. doi:10.1093/asj/sju019. ISSN 1527-330X.
  15. Sforza, Marcos; Andjelkov, Katarina; Zaccheddu, Renato; Nagi, Hussein; Colic, Miodrag (2011-08). "Transversus Abdominis Plane Block Anesthesia in Abdominoplasties". Plastic and Reconstructive Surgery. 128 (2): 529–535. doi:10.1097/prs.0b013e31821e6f51. ISSN 0032-1052. Check date values in: |date= (help)
  16. Alotaibi, Nawaf Naif; Ahmad, Tawheed; Rabah, Sari Monzer; Hamza, Aljohara Mohmoud; Mohammad Tafazul, Sheikh (2021-01-05). "Evaluation of transversus abdominis plane (TAP) block in lipoabdominoplasty surgical procedure: a comparative study". Journal of Plastic Surgery and Hand Surgery. 55 (4): 216–219. doi:10.1080/2000656x.2020.1856676. ISSN 2000-656X.
  17. 17.0 17.1 Gravante, Gianpiero; Castrì, Francesca; Araco, Francesco; Araco, Antonino (2010-06-02). "A Comparative Study of the Transversus Abdominis Plane (TAP) Block Efficacy on Post-bariatric vs Aesthetic Abdominoplasty with Flank Liposuction". Obesity Surgery. 21 (3): 278–282. doi:10.1007/s11695-010-0203-2. ISSN 0960-8923.
  18. Perez, Mauricio E.; Hoyos, Alfredo E. (2020-10-08). "Invited Discussion on: Evaluation of the Effect of Erector Spinae Plane Block in Patients Undergoing Belt Lipectomy Surgery". Aesthetic Plastic Surgery. 44 (6): 2143–2146. doi:10.1007/s00266-020-01944-3. ISSN 0364-216X.
  19. Feng, Lu-Jean (2010-11). "Painless Abdominoplasty: The Efficacy of Combined Intercostal and Pararectus Blocks in Reducing Postoperative Pain and Recovery Time". Plastic and Reconstructive Surgery. 126 (5): 1723–1732. doi:10.1097/prs.0b013e3181ef8fe5. ISSN 0032-1052. Check date values in: |date= (help)
  20. Rudkin, Glenda E.; Gardiner, Sarah E.; Cooter, Rodney D. (2008-02). "Bilateral thoracic paravertebral block for abdominoplasty". Journal of Clinical Anesthesia. 20 (1): 54–56. doi:10.1016/j.jclinane.2007.06.020. ISSN 0952-8180. Check date values in: |date= (help)
  21. Seretis, Konstantinos; Bounas, Nikolaos (2022-12-06). "The Efficacy of Different Nerve Blocks on Postoperative Pain and Sequelae in Patients Undergoing Abdominoplasty: A Network Meta-Analysis". Aesthetic Surgery Journal. 43 (5): NP325–NP336. doi:10.1093/asj/sjac319. ISSN 1090-820X.