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

Discussion

The use of preoperative oral diazepam in patients undergoing primary breast augmentation did not improve perioperative or immediate postoperative outcomes.

Patients undergoing breast augmentation frequently report pain, with a higher incidence in those women who received submuscular coverage of the implant.[2] Unfortunately, opioids, the mainstay treatment of pain, are well known to cause postoperative nausea and vomiting, as well as carry the risk of developing dependence. Premedication with benzodiazepines in some studies has demonstrated fewer postoperative side effects, including postoperative nausea, without delaying recovery time.[7,8]

In this study, we found no benefit of premedication with diazepam. While immediate postoperative pain was similar between the control group and those receiving diazepam premedication, the postoperative narcotic use and predischarge pain scores were significantly higher in the diazepam group. Caumo et al[9] found a direct correlation between preoperative anxiety and higher postoperative pain. Other studies have found that the quality of recovery after premedication was no different from controls but the perioperative experience was improved.[8] While our findings of increased postoperative pain and narcotic use may be statistically significant, the difference in pain and narcotic use is likely clinically insignificant.

The mean operative time was found to be approximately 6 minutes longer in the control group (P = .006). This could be due to increasing operative efficiency among the surgeons, as the control group underwent augmentation mammoplasty during an earlier time point. However, all surgeons included in the study had a minimum of 4 years in practice following training.

Another interesting finding of this study was the lack of correlation between implant size and postoperative pain or perioperative opioid use. Among patients undergoing breast augmentation, chronic pain was more prevalent in those who underwent submuscular implant placement than in those with subglandular placement.[2] It would be reasonable to assume that if the muscle was subjected to increased stress with a larger implant, patients would experience more pain. However, our data did not support that trend. Tebbetts[10] found that meticulous technique and careful dissection of the submuscular pocket were associated with significantly decreased postoperative pain scores. Based on our findings, it is possible that the pain associated with submuscular placement of the implant is related to trauma of the muscle during dissection rather than the stretch necessary to accommodate the device.

Total opioid use was found to be higher in patients with larger preoperative breast size (B or C) than in those with smaller preoperative size (AA or A). In these patients, however, the increased narcotic use was seen intraoperatively rather than postoperatively. In addition, the implant volume and body mass index were found to be significantly higher in patients within the larger breast size group (B or C). These patients may have had more redistribution of medications during anesthesia requiring higher doses for adequate anesthesia. Conversely, these patients did have larger devices placed that could account for the increased opioid use.

This study did not demonstrate any perioperative benefit of diazepam premedication in primary augmentation mammoplasty. Selective use of anxiolytics may provide the most benefit for patients rather than using anxiolytics in all patients.

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