Painless Abdominoplasty: The Efficacy of Combined Intercostal and Pararectus Blocks in Reducing Postoperative Pain and Recovery Time

Background: Reducing postoperative pain following abdominoplasty is essential for shortening the length of recovery time, reducing the use of narcotics, promoting quicker return to normal activities, and maximizing overall patient satisfaction. The extended use of narcotics and pain pumps is often unacceptable because of nausea, restriction of normal activities, and inconvenience. When the recovery process is not too lengthy and debilitating for the patients, they are more likely to refer the procedure to others and to return for additional elective procedures. Methods: The charts of 209 patients undergoing abdominoplasty over a 10-year period were reviewed. The control group (n = 20) received no blocks, whereas the treatment group (n = 77) received a combination of nerve blocks, using bupivacaine, tetracaine, and Depo-Medrol. Recovery room data and patient questionnaires were used to evaluate clinical efficacy. Patient procedures were classified into four severity classes for analysis. Results: The treatment group had significantly less pain across all severity classes and required significantly less narcotics and less time in the recovery room. Pain scores continued to be significantly lower at home. Patients had significantly less nausea, took less pain medication, and resumed normal activities significantly sooner than the control group. Conclusions: This is the first study showing successful long-term relief of pain associated with abdominoplasty using a combination of intercostal, ilioinguinal, iliohypogastric, and pararectus blocks. This pain-block procedure significantly reduces the recovery time and allows the patient to return to normal activities and work much sooner. (Plast. Reconstr. Surg. 126: 1723, 2010.)