Diazepam Premedication in Primary Augmentation Mammoplasty

Elizabeth A. Lucich, MD; Nicholas S. Adams, MD; Renee L. Barry, MD; Joshua J. Nelson, MD; Joshua P. Kelley, MD; John D. Renucci, MD

Disclosures

ePlasty. 2020;20(e2) 

In This Article

Abstract and Introduction

Abstract

Goals/Purpose: To evaluate the effects of preoperative oral diazepam on the postoperative course of patients undergoing primary augmentation mammoplasty in an outpatient surgical center.

Methods/Technique: A retrospective review was conducted of 189 patients undergoing primary breast augmentation at an outpatient surgical center from 2012 to 2015. Patients receiving same-day premedication with oral diazepam were compared with a control group without premedication. Patients with combined surgical procedures were excluded with the exception of minor, superficial procedures. Patient demographics, perioperative medication use, operative details, and postoperative numeric pain scale (0–10) scores were collected.

Results/Complications: Ninety-three patients (49%) were included in the premedication group and 96 (51%) in the control group. Difference in age, body mass index, implant size, and intraoperative opioid use were not statistically significantly different between the treatment and control groups (P > .05). No difference was noted in postoperative nausea, emesis, or antiemetic use between the 2 groups. The operative time was slightly longer in the control group (64.5 minutes vs 58.5 minutes, P = .006). Immediate postoperative pain (3.6 vs 4.4) and time to discharge (101 minutes vs 110 minutes) were slightly decreased in the premedication group; however, these values did not reach statistical significance. Intraoperative narcotic use was the same between groups, but postoperative narcotic pain medication use was higher in the premedication group (9.68 mg vs 8.26 mg, P = .036). Predischarge pain scores (2.87 vs 2.29, P = .006) were also noted to be slightly higher in the premedication group.

Conclusions: Preoperative diazepam administration does not significantly decrease time to discharge in primary breast augmentation mammoplasty. Furthermore, its use may result in increased postoperative narcotic use and higher pain scores at the time of discharge.

Introduction

Breast augmentation remains one of the most common cosmetic surgical procedures performed in the United States, with 313,735 surgical procedures performed in 2018.[1] With an increasing focus on patient satisfaction and the popularity of breast augmentation procedures, it is important that measures are taken to improve patient outcomes and satisfaction. This particular procedure can be associated with adverse effects secondary to surgical technique and due to the anesthesia administered. Patients may have significant pain and discomfort postoperatively, especially when submuscular dissection is performed.[2] Anesthetic side effects include headache, nausea, vomiting, and altered mental status.[3] In addition, the use of postoperative opioids has been significantly associated with the development of postoperative nausea and vomiting.[4]

Providing adequate pain control is often a difficult task and a single approach is not appropriate for all patients.[3] In the past, there has been concern that premedication with anxiolytics could delay time to discharge following day surgery but this has been shown to not hold true in a recent Cochrane review.[5] Recent data showed that higher preoperative doses of diazepam significantly reduced fentanyl requirements, resulting in shorter recovery times, decreased postoperative nausea/vomiting, and elimination of unintended admissions in breast augmentation.[6] The goal of this study was to determine the effects of preoperative diazepam on the perioperative course of patients undergoing primary augmentation mammoplasty under general anesthesia, with the hypothesis that the use of preoperative diazepam will improve perioperative course.

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