October 2019 #PRSJournalClub Wrap-Up: “Safety of Postoperative Opioid Alternatives in Plastic Surgery: A Systematic Review”

by Dominic Henn, MD
Postdoc, Plastic and Reconstructive Surgery, Stanford University
Plastic Surgery Resident, BG Trauma Center Ludwigshafen/Heidelberg University


The October edition of #PRSJournalClub provided an excellent discussion of an important systematic review in PRS entitled “Safety of Postoperative Opioid Alternatives in Plastic Surgery” by O’Neill, Hayes, and Davison. The article can be read here.

In the study, O’Neill et al. conducted a systematic review about the efficacy and safety of non-opioid analgesics such as nonsteroidal anti-inflammatory drugs and local anesthetic blocks in plastic surgery patients. Especially given the growing opioid epidemic, this is an extremely important topic for all plastic surgeons and for our specialty.The authors performed a comprehensive search of the PubMed and MEDLINE databases and their inclusion and exclusion criteria yielded 34 relevant articles. Their systematic review found that ibuprofen, celecoxib, or ketorolac had not been significantly associated with bleeding complications. An increased risk of adverse events was also not reported for intravenous acetaminophen, ketamine, gabapentin or liposomal bupivacaine. Nerve and infusion blocks showed a low risk of pneumothorax. In their comprehensive review, O’Neill, Hayes, and Davison demonstrate that several analgesics have a role as opioid alternatives after plastic surgery procedures. In the current opioid crisis, this article is of outstanding importance and encourages plastic surgeons to spearhead the campaign to decrease opioid use by relying on multimodal pain regimens involving non-opoid analgesics. 

The article was first discussed by the current Resident Ambassadors to the PRS Editorial Board Raj Parikh, MD, Lily Mundy, MD, and Kyle Sanniec, MD—and special guest Adeyiza O. Momoh, MD. Listen to the podcast discussion below:

An engaging and thouhgt-provoking online discussion also took place on the #PRSJournal Facebook page over a two-day period (October 19-20), which enabled a broad audience to ask questions and interact directly with the authors. Don’t worry if you missed it! A summary of the interesting discussion is provided here. 

We hope you enjoy the top highlights from the discussion and look forward to seeing you at the next #PRSJournalClub on Facebook! 

Sincerely, 
Dominic

This October #PRSJournalClub article (as well as other Journal Club selections from October), selected classic pairings and videos, and the entire Facebook Q&A are archived on PRSJournal.com here.

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