Pain management after lipoplasty: a study of 303 cases

BACKGROUND: The safety and efficiency of liposuction have been proven in several studies, but little attention has been paid to postoperative pain. The present study was designed to determine the demand for analgesic agents used postoperatively after liposuction. METHODS: A total of 303 patients underwent ultrasound-assisted liposuction between January 1, 1999, and February 1, 2002, in the Department of Plastic Surgery at the Florence Nightingale Hospital, in Dusseldorf, Germany. The study is partly retrospective of the postoperative demand for analgesic agents. RESULTS: The study group of 244 female and 59 male patients was 42.2 +/- 13.6 years of age (range, 12 to 78 years). The average total suction volume removed was 2404.6 +/- 1704.2 cc (range, 90 to 9100 cc). Of 303 patients, 146 (48.2 percent) did not require any additional analgesic agents on the day of the operation, with 157 (51.8 percent) asking for pain relief on the operation day. On the first postoperative day, 88 (29.0 percent) of all liposuction patients asked for pain medication. That number of patients decreased to 28 (9.2 percent) on postoperative day 2, 21 (6.9 percent) on postoperative day 3, 11 (3.6 percent) on postoperative day 4, five (1.7 percent) on postoperative day 5, four (1.3 percent) on postoperative day 6, and zero on postoperative day 7. The data were further specified concerning details on analgesic agents. Of 303 patients, 146 (48.2 percent) did not require any form of pain medication. For 61 patients (20.1 percent), light analgesic agents were sufficient. Eighty-three patients (27.4 percent) asked for stronger medication, such as tramadol. Only 13 patients (4.3 percent) needed strong opioids for adequate pain management. No statistically significant difference concerning postoperative pain was observed between patients who were operated on under local anesthesia and those who received general anesthesia. CONCLUSIONS: This study gives clear proof that liposuction is a relatively painless procedure, and 48.2 percent off all liposuction patients do not need any pain medication at all. If they do need analgesic agents postoperatively, in most cases, analgesic therapy is sufficient with oral pain medication such as paracetamol or tramadol. In addition, patients can be reassured that merely 1 week after the operation very few patients complain of pain, and they can return to normal life without any complications concerning pain.

Critical review of oral drug treatments for diabetic neuropathic pain-clinical outcomes based on efficacy and safety data from placebo-controlled and direct comparative studies

The present review aims to evaluate the efficacy and safety of a selection of oral treatments for the management of painful diabetic neuropathy. A literature review was conducted retrieving placebo-controlled and direct comparative studies with a selection of oral treatments for painful diabetic neuropathy. All studies were analyzed with regard to efficacy and tolerability. Efficacy was evaluated as the percentage improvement in pain intensity between baseline and endpoint. Tolerability was evaluated by means of study discontinuations due to adverse events and by incidence of drug-related adverse events.The analyzed trials enrolled different patient populations with mostly small numbers of patients. The great variability in dosages and dose titration schemes, cross-over designs with variable wash-out periods, and other design schemes made comparison between the different studies difficult. Gabapentin, lamotrigine, tramadol, oxycodone, mexiletine, and acetyl-L-carnitine were the only treatments studied in large (at least 100 patients), placebo-controlled parallel group trials.It is concluded that standardization in design and reporting for comparison of treatments is needed. Validated questionnaires for evaluation of the efficacy and safety should be further developed. Based on the reviewed randomised controlled trials, gabapentin shows good efficacy, a favourable side-effect profile with lack of drug interactions and therefore it may be a first choice treatment in painful diabetic neuropathy, especially in the elderly. However, head to head trials of current treatments are lacking and therefore randomized controlled trials are required to address this issue

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