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 | |
| 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
A. 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]
B. Neuraxial Techniques: useful when the patient has higher risk cardiac complications, respiratory complications, malignant hyperthermia (HM), and rhabdomyolysis from anesthesia [7].
o Combined spinal-epidural anesthesia [7][8]
· Safely provide adequate pain control in high risk GA patients
o Spinal anesthesia [9]
· May consider when the surgery is expected to be <3h
· Decreased needs for post-op opiates
· Patients able to ambulate in shorter amount of time (better DVT prevention)
o Epidural anesthesia [10]
· Appears to be feasible
· May decrease risk of DVT
C. Others
o Rib block + IV sedation [11]
· Decreased time in recovery room, postoperative narcotics, postoperative nausea and vomiting
Intraoperative management
Monitoring and access
Standard ASA monitors
Induction and airway management
Standard induction, consider video laryngoscopy if concern for difficult direct laryngoscopy
Positioning
Supine
Secure arms / Check IV
Maintenance and surgical considerations
Standard maintenance
Maintain normothermia
Emergence
Smooth emergence, 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 below.
Regional Anesthesia Techniques
· Quadratus lumborum (QL) block
I. Inconsistent results with regard to sparing of post-op opiates [12][13]
II. Better pain control [12]
· Transversus abdominis plane (TAP) block [14][15][16][17][18]
I. Decrease needs for post-op opiates
II. Early ambulation
III. Possibly less effective in post-bariatric surgery patient due to more traumatic operation [18]
· Erector spinae plane block [19]
I. Decrease needs for post-op opiates
II. Early ambulation
· Combined intercostal and pararectus blocks [20]
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 [21][22] blocks, can possibly be used/helpful
Potential major complications [1]
DVT/PE, respiratory compromise, abdominal compartment syndrome, systemic infections
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Indications | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
- ↑ 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) - ↑ 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) - ↑ 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) - ↑ 4.0 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.
- ↑ 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.
- ↑ 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) - ↑ 7.0 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) - ↑ 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) - ↑ 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.
- ↑ Gutowski, K.A. (2013-01). "Epidural Anesthesia as a Thromboembolic Prophylaxis Modality in Plastic Surgery". Yearbook of Plastic and Aesthetic Surgery. 2013: 74. doi:10.1016/j.yprs.2012.07.012. ISSN 1535-1513. no-break space character in
|title=at position 23 (help); Check date values in:|date=(help) - ↑ 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) - ↑ 12.0 12.1 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.
- ↑ 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.
- ↑ 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) - ↑ 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.
- ↑ 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) - ↑ 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.
- ↑ 18.0 18.1 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.
- ↑ 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.
- ↑ 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) - ↑ 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) - ↑ 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.
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