POSTOPERATIVE PAIN AND MULTIMODAL ANESTHESIA IN ABDOMINAL PLASTIC AND BARIATRIC SURGERY

Abstract

Any rational anesthesia strategy should focus on intraoperative and postoperative pain control. Adverse effects of opioids on the course of the early postoperative period are known. The aim of our study is to determine the correlations of acute postoperative pain with different types of anesthesia. Methods 203 patients who underwent abdominal plastic and bariatric surgery were under our observation; 113 (55.67%) of them are women and 90 (44.33%) are men; Among them, 154 patients underwent abdominoplasty, and 49 underwent bariatric surgery. Standard anesthesia with opioids was administered to 49 (24.14%) patients - group I, multimodal + partial use of opioids - group II: 76 (37.44%), multimodal anesthesia - 78 (38.42%) - group III. Results During anesthesia with opioids, compared to the second and third groups, the pain in the operative area, as well as in the head, throat, waist and ears is significantly higher. During multimodal anesthesia, pain is reliably less in all cases, and pain in the throat was not noted. Correlation analysis showed that opioid anesthesia was significantly correlated with postoperative pain,: Pain in the operated area - r=0.504**, p<0.001; Head pain - r=0.395**, p<0.001; Throat pain - r=0.301**, p<0.001Waist painr=0.320**, <0.001, Muscles pain - r=0.422**, p<0.001 whereas multimodal anesthesia was significantly negatively correlated with all types of postoperative pain. In the second phase, in the opioid anesthesia group, compared to the second group, there is significantly more pain in the lower back and muscles, and in the third group, there was no pain at all. The frequency of patients who did not require medical treatment during the intrahospital stage is not significantly different from each other, and the pain requiring non-opioid treatment is significantly less after multimodal anesthesia - Group I - 28(57.14%), Group II - 25(32.89%), Group III - 2(2.56)(p<0.0001). Pain requires opioid medication - Group I - 20(40.82)Group II – 19(25.00%), (p<0.0001). No patient in this group required opioid treatment. In the ambulatory stage, no patient in the multimodal anesthesia group needed medical treatment, and significantly fewer patients in group II needed non-opioid treatment. Conclusion Multimodal anesthesia reduces perioperative pain and the need for perioperative opioid use. Keywords: Postoperative pain, Multimodal anesthesia, perioperative opioid use.