Optimizing Recovery in Abdominoplasty
Optimizing Recovery in Abdominoplasty
The overall purpose of this study is to evaluate the analgesic efficacy of liposomal
 bupivacaine in optimizing pain control, minimizing the risk of postoperative nausea and
 vomiting (PONV), and improving recovery after abdominoplasty. This will be done by comparing
 intraoperative abdominal wall and incisional injection of bupivacaine to bupivacaine plus
 liposomal bupivacaine in 46 participants 18 years and older undergoing elective
 abdominoplasty. This will be studied using pain assessments, validated surveys, medication
 logs and review of medical records.
Postoperative pain, nausea, and vomiting can be frustrating sequelae of elective surgery.
 Poorly managed postoperative pain can lead to increased opioid use, increased postoperative
 nausea and vomiting (PONV), delayed return to work and usual activities, unplanned hospital
 admissions, surgical complications, and patient dissatisfaction. In light of the growing
 opioid epidemic in the United States, any intervention that potentially minimizes opioid use
 may have meaningful individual and societal impact. Despite the use of multiple techniques
 for managing postoperative pain in abdominoplasty patients, pain control continues to be a
 challenge for this patient population.

 One technique commonly employed to improve pain control is the use of abdominal wall and
 incisional injection of local anesthetic agents to block the sensory nerves supplying the
 anterior abdominal wall and abdominal incisions in order to decrease sensation and pain in
 the abdomen in the setting of abdominoplasty surgery. Local anesthetic often used in this
 procedure is bupivacaine (Marcaine) ± epinephrine. However, in 2012, a liposomal bupivacaine
 suspension (Exparel; Pacira BioSciences, Inc, San Diego, California) was introduced as a
 longer-acting local anesthetic used for management of postoperative pain. At the University
 of Wisconsin, patients undergoing abdominoplasty routinely receive intraoperative injection
 of local anesthetic to the abdominal wall and abdominal incisions, using bupivacaine as the
 local anesthetic, along with standard multimodal perioperative pain management including cool
 compresses, non-steroidal anti-inflammatories (NSAIDs), acetaminophen, and opioids.

 The overall purpose of this study is to evaluate the analgesic efficacy of liposomal
 bupivacaine in optimizing pain control, minimizing the risk of PONV, and improving recovery
 after abdominoplasty. This will be done by comparing intraoperative abdominal wall and
 incisional injection of bupivacaine to bupivacaine plus liposomal bupivacaine in patients
 undergoing abdominoplasty. This will be studied using pain assessments, validated surveys,
 medication logs and review of medical records.
Inclusion Criteria:

 -  Medically cleared to undergo elective surgery (including associated anesthesia) at UW
 Transformations Surgery Center

 Exclusion Criteria:

 -  Pregnant or breast-feeding women

 -  Incarcerated women or men

 -  Individuals unable to give consent due to another condition such as impaired
 decision-making capacity.

 -  Men or women who take opioid pain medications on a regular basis prior to surgery

 -  Men or women with a history of opioid abuse and/or dependence

 -  Participants with a history of bleeding disorders precluding safe abdominoplasty

 -  Participants on anticoagulation therapy who have not held their anticoagulation as
 recommended by their surgeon or anesthesiologist

 -  Participants not medically cleared for surgery at Transformations Surgery Center. This
 would include participants with sepsis/bacteremia, significant valvular disorders or
 heart conditions.