Bilateral Breast Reduction Without Opioid Analgesics: A Comparative Study.

Area of Science:

• Plastic Surgery
• Anesthesiology
• Pain Management

Background:

• Traditional breast reduction often involves general anesthesia and opioid use, which carry significant risks.
• Opioids can cause adverse effects like nausea, vomiting, constipation, sedation, dizziness, and addiction.

Purpose of the Study:

• To compare a multimodal opioid-free pain management regimen with traditional opioid-based anesthesia for bilateral breast reduction.
• To evaluate the safety and efficacy of opioid-free breast reduction techniques.

Main Methods:

• 83 female patients underwent bilateral breast reduction.
• Group 1 (retrospective, n=39) received general anesthesia with opioids.
• Groups 2 (prospective, n=26) and 3 (prospective, n=18) received opioid-free multimodal pain management (gabapentin, celecoxib, local anesthetics) under IV sedation/local anesthesia or general anesthesia, respectively.

Main Results:

• Opioid-free groups (2 and 3) showed a significantly shorter time from surgery end to home discharge (P < 0.05).
• Fewer unplanned hospital admissions were observed in the opioid-free groups (P < 0.05).
• A highly significant decrease in postoperative opioid use was noted in groups 2 and 3 (P < 0.001).

Conclusions:

• A multimodal opioid-free approach enables safe outpatient bilateral breast reduction under local or general anesthesia.
• This method significantly reduces morbidity, postoperative opioid use, and unplanned hospital admissions compared to traditional opioid-based procedures.