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Preemptive Analgesia with Bupivacaine in Reduction Mammaplasty: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial

Valente, Denis S. M.D.

Plastic and Reconstructive Surgery: October 2014 - Volume 134 - Issue 4 - p 581–586
doi: 10.1097/PRS.0000000000000522
Breast: Original Articles
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Background: Preincisional analgesia is an antinociceptive treatment that prevents altered central excitability from high-intensity noxious stimuli. To determine the analgesic efficacy of preoperative infiltration with bupivacaine for reduction mammaplasty, a randomized, double-blind, placebo-controlled trial was designed.

Methods: Women with mammary hypertrophy were allocated randomly to one of two study groups. Patients in group I received preincision infiltration with bupivacaine into each breast after general anesthesia. Group II patients received similar injections of saline injection alone after general anesthesia.

Results: Visual analogue pain score, verbal pain score, and short-form McGill Pain Questionnaire scores were higher in group II patients until 22 hours after surgery (p < 0.008). Patients in the saline group had higher intravenous meperidine consumption for 22 hours postoperatively and solicited opioids before the patients in the bupivacaine group (p < 0.001). The difference between groups was statistically significant.

Conclusion: Preincisional infiltration with bupivacaine results in reduced pain and lower postoperative opioid requirements in the early postoperative phase of pain following breast reduction.


Porto Alegre, Brazil

From the Division of Plastic Surgery and Reconstructive Microsurgery, Santa Casa Hospital; and the Division of Plastic Surgery, Mãe de Deus Health System.

Received for publication January 19, 2014; accepted February 13, 2014.

Disclosure: The author has no commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this study. The author has no financial interest in any of the products, devices, or drugs mentioned in this article. This study has not received any supporting funds.

Denis S. Valente, M.D., Av. Verissimo de Amaral 580-1704, Porto Alegre, Rio Grande do Sul 91360-470, Brazil,

©2014American Society of Plastic Surgeons