Large area local anesthesia (LALA) in submuscular breast augmentation

Large area local anesthesia (LALA) has been recommended for decreasing localized pain and shortening discharge time after breast augmentation surgery. However, quantifiable, objective outcome data for evaluation of the effectiveness of LALA in aesthetic plastic surgery procedures have not yet been reported.

We conducted a retrospective patient chart review to determine whether irrigation of the submuscular pocket with bupivacaine in retropectoral breast augmentation procedures quantifiably alters the patient's postoperative course with respect to narcotic requirement, nausea and vomiting, and time to discharge. The findings were evaluated in the context of a critical review of the literature dealing with pain management after breast augmentation, and in particular with the use of LALA.

All procedures were performed by the senior author in a private surgical facility. All patients received an identical general anesthetic plus local infiltration of incisions with 1% lidocaine with epinephrine. An inframammary approach was used in all cases; retropectoral dissection was performed with electrocautery dissection followed by hemostasis. In one cohort of patients the submuscular pocket was irrigated with 10 mL of 0.125% bupivacaine before dissection of the contralateral side; in a second control cohort it was not. Postoperative care was the same for both groups.

We found a trend toward decreased nausea and vomiting and narcotic use, and a statistically significant decrease in time to discharge, for the cohort that received intraoperative bupivacaine irrigation.

LALA is an effective means to decrease recovery time and possibly postoperative pain, nausea and vomiting, and narcotic requirements. Because evidence-based medicine is the surest basis for clinical decisions, evaluation of LALA as well as other treatment modalities should include quantifiable outcome measures.