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dc.contributor.authorBar-Meir, Eran D.
dc.contributor.authorYueh, Janet H.
dc.contributor.authorHess, Philip E.
dc.contributor.authorHartmann, Christoph E. A.
dc.contributor.authorMaia, Munique
dc.contributor.authorTobias, Adam M.
dc.contributor.authorLee, Bernard Travis
dc.date.accessioned2011-03-08T18:57:57Z
dc.date.issued2010
dc.identifier.citationBar-Meir, Eran D., Janet H. Yueh, Philip E. Hess, Christoph E. A. Hartmann, Munique Maia, Adam M. Tobias, and Bernard T. Lee. 2010. Postoperative pain management in DIEP flap breast reconstruction: Identification of patients with poor pain control. Eplasty 10: 483-491.en_US
dc.identifier.issn1937-5719en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:4739300
dc.description.abstractObjective: Adequate control of postoperative pain directly improves patient satisfaction and outcomes, and timely identification of patients with poorly controlled pain is essential. Pain management protocols are best studied in patients recovering from the same operation. In our institution, the postoperative pain regimen for patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction is standardized using patient-controlled analgesia (PCA) followed by conversion to oral narcotics. From this uniform population, we were able to identify a subgroup of patients with poor pain control. Methods: Over a 44-month period, 179 consecutive patients underwent DIEP flap breast reconstruction with 242 flaps performed. A retrospective chart review recorded PCA usage, visual analog scale pain scores, and length of stay. Results: Pain management with PCA after DIEP flap breast reconstruction was uniformly controlled. Most patients (74.9%) required PCA usage in the first 2 days with conversion to oral analgesics. A subgroup of patients (25.1%) continued to require PCA usage on the third postoperative day. These “nonresponder” patients had a higher visual analog scale score on the first postoperative day, higher total intravenous morphine use, and a longer length of stay (all, P less than .05). A multivariate analysis revealed more nonresponders among patients undergoing immediate breast reconstruction (P less than .05); however, all other factors analyzed had no correlation. Conclusion: We report a subgroup of patients with poor pain control after DIEP flap breast reconstruction. This group of patients required a longer course of pain management and subsequently a longer hospital stay. Pain management protocols that identify these patients promptly can allow for appropriate modifications.en_US
dc.language.isoen_USen_US
dc.publisherOpen Scienceen_US
dc.relation.isversionofwww.eplasty.comen_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941188/pdf/en_US
dash.licenseLAA
dc.titlePostoperative Pain Management in DIEP Flap Breast Reconstruction: Identification of Patients With Poor Pain Controlen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalEplastyen_US
dash.depositing.authorHess, Philip E.
dc.date.available2011-03-08T18:57:57Z
dash.affiliation.otherHMS^Anaesthesia- Beth Israel-Deaconessen_US
dash.contributor.affiliatedTobias, Adam
dash.contributor.affiliatedLee, Bernard
dash.contributor.affiliatedHess, Philip


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