A Blast from BIEL's Past circa 2005 Abdominopla

A Blast from BIEL's Past circa 2005

Abdominoplasty Post-Operative Pain Control With ActiPatch, Goh, Kimberley, MD

Grand Strand Plastic and Reconstructive Surgery Center, P.A.
Myrtle Beach, SC 29577

An abdominoplasty is one of the most painful cosmetic body contouring procedures we perform. Fear of post-operative pain has always been an obstacle for patients when considering an abdominoplasty. There is now a new, portable, lightweight and low cost way to decrease postoperative pain. The ActiPatch is a device which produces pulsed electromagnetic therapy that helps reduce swelling, relieve pain and enhance healing.*

I have been using the ActiPatch 500 for postoperative abdominoplasties for about six months and have been very impressed at its pain control. Prior to ActiPatch I had been using oxycodone and diazepam for postoperative pain control with intra-operative marcaine placed under the flap prior to emergence from anesthesia. The patients complained of significant pain and usually needed additional prescriptions for both pain and muscle relaxers within four days of surgery and often again at one week. Since using ActiPatch postoperatively I have not written a supplemental prescription for pain control and they have some left over. Their narcotic and medication needs have now decreased approximately seventy five percent.

Initially four patients were placed on ActiPatch for pain control after abdominoplasties. All patients had standard abdominoplasties with muscle and skin tightening; one had an augment performed as well. The charts were reviewed and interviews performed retrospectively to the physician to evaluate postoperative pain and narcotic use.

The first patient, A., was a 44 year old woman who had three full term pregnancies and several months of nursing. She complained of loss of breast fullness and a saggy abdomen. Physical exam revealed ptosis and pseudoptosis of her breasts and a lax abdominal wall, especially the upper abdomen, and loose skin on the upper and lower abdomen. She underwent a standard abdominoplasty and a bilateral subglandular breast augment. The breast augment was performed using a smooth round saline Mentor implant 350cc filled to 400cc in subglandular position through an inframammary incision. The abdominoplasty resected about 40 X 13 centimeters of skin, and the diastasis recti was corrected (about an eight centimeter plication). Fourteen cc of ¼% marcaine was placed under the flap at closure. As the patient was emerging from anesthesia the ActiPatch 500 was placed on the epigastrum and attached using its adhesive pad directly on the skin.

In recovery she needed one oxycodone for immediate postoperative pain. The evening of surgery she rested comfortably, and on her first visit on postoperative day one she came for her appointment wearing makeup with her hair styled and had minimal complaints of pain. She had been taking only one oxycodone every six hours because she was afraid that it would hurt, but had no complaints of abdominal pain. She had her oxycodone changed to mepergan because of nausea, but used very little her first week. She said she felt "she could have run a marathon" and could not believe how little pain she had.

Patient B was a 30 year old woman with two full term pregnancies who complained of a lax abdomen after multiple pregnancies and a previous cesarean section five years prior. She underwent a standard abdominoplasty. Of note is that she had undergone a scheduled knee surgery two days prior to her abdominoplasty in order to make her recovery simultaneous. At surgery she had a 14 X 46 centimeter skin resection and an eight centimeter tightening of her diastasis recti. Fifteen cc of ¼% marcaine was placed under the flap at closure. The ActiPatch 500 was activated and placed directly on the epigastrum after the wound was closed. In recovery she had one oxycodone given orally. The first evening postop she used less than one oxycodone and one diazepam every six hours. The first day postop she complained only of knee pain, and felt that the abdominoplasty was less painful than her previous cesarean section. She also came in wearing facial cosmetics and had her hair styled on her first day after surgery. Her first week post op she also used less than 20 each of diazepam and oxycodone.

Patient C was a33 year old nulliparous woman with a previous submuscular augment mastopexy who complained of inability to tighten her lower abdomen with diet and exercise. She underwent a standard abdominoplasty with resection of approximately 13 centimeter by 43 centimeter skin ellipse, and an eight centimeter diastasis recti plication. Postoperatively she had an ActiPatch 500 activated and applied to her epigastrum. In the recovery room she had one oxycodone orally for pain. The evening of surgery she took one and one 5 mg diazepam. By the evening of surgery her only pain was on moving to stand or recline. At rest she was pain free and reported less pain than her previous augment mastopexy. The following week she took one or two oxycodone a day.

Patient D was a 56 year old with one full term pregnancy who was interested in improving her saggy lower abdomen. She had a previous lower midline incision for a cesarean section and a right lower quadrant incision for a bone graft donor site. She had significant diastasis recti and a small abdominal pannus. She underwent a standard abdominoplasty with repair of diastasis and right lower quadrant plication for asymmetrical laxity. She had a 15 X 42.5 skin resection and a six centimeter plication. She had 12 cc of ¼% marcaine placed prior to emergence under the flap. Postoperatively she had one ActiPatch 500 device placed on the epigastrum. In the recovery room she had one oxycodone, and the first evening of surgery, one diazepam and one oxycodone. The next few days she was taking one to two diazepam once a day and one oxycodone four times a day. By the end of her first week she had taken about twenty of the oxycodone and even less of the diazepam.

The amount of pain relief with the ActiPatch after a major surgery is impressive. This retrospective review of patients' charts and interviews demonstrates a marked decrease in postoperative pain and use of narcotics in abdominoplasty. While the ActiPatch can assist with healing and reduce swelling, those benefits are difficult to appreciate in actual clinical practice. The amount of pain relief however is easier to evaluate. There is a marked decrease in the use of pain medications and as well as a significant increase in comfort level. It is currently a low cost, small, portable, narcotic free pain control device, and should be considered in all major abdominal surgeries.

Postoperative pain in an abdominoplasty is usually severe, and requires significant amounts of narcotics and muscle relaxers to control. The ActiPatch is a new device that suppresses pain without narcotics. It is a small, disposable, affordable and easily applied external device that is a radiofrequency generator. It has been promoted for decreasing swelling, accelerating wound healing (radiofrequency used in orthopedics to accelerate boney union) and for pain control. Byron Medical is the distributor for plastic surgeons.

I have found that using the ActiPatch for pain control has made a tremendous difference in my patients' recovery after an abdominoplasty. I now use it on all of my abdominoplasties. I started applying it to my abdominoplasty patients in 2003 and some of other patients who were concerned about postoperative pain control, and desired to be off medication sooner to be able to return to work. I have not been comfortable using the pain pumps, especially in those patients who have an implant because of the theoretical potential for introducing bacteria. This is a simpler, cleaner and less expensive way to approach surgical pain.

The response is impressive. I did a retrospective review of my abdominoplasty patients and looked at the number and amount of the pain medication prescriptions. I wrote for about one fourth of the usual amount if I used the ActiPatch. Prior to the ActiPatch they were using about two oxycodone and ten milligrams of valium every four hours the first few days. After I began using the ActiPatch, they were using about one fourth of the drugs in the first week. Also three of these abdominoplasty patients came to my office on the first day postoperatively with makeup on and their hair done. (The other did not wear makeup preop.) That was a first! I was using the ActiPatch 500 applied to the epigastrum in the operating room immediately after the procedure. I have also used it on my breast augment patients and reduction patients that seem to have a lower pain threshold, with good results.

I have had some of my abdominoplasty patients decide that their back bothered them more than their abdomen after a week or so and moved the ActiPatch from their abdomen to their back, and found relief. One got so much relief from her chronic back pain that she came back and bought three for a long trip to New Zealand! She has asked me if I mind her buying it for her back during the year.

ActiPatch for pain control is worthwhile in the postoperative patient, it allows less narcotic use. The cosmetic patient has a great appreciation for the earlier discontinuation of narcotics, and it should be considered for those procedures associated with significant postoperative pain.

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