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Opioid Consumption after Plastic Surgery: Tailoring Opioid Administration to Patient Needs

Kendall, Mark C. M.D.

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Plastic and Reconstructive Surgery: January 2020 - Volume 145 - Issue 1 - p 216e-217e
doi: 10.1097/PRS.0000000000006237
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I read with great interest the article by Rose et al. in a recent issue of the Journal.1 The authors studied 170 patients undergoing plastic surgery and concluded that plastic surgeons are prescribing almost double the amount of opioids consumed by patients after outpatient plastic surgery procedures. The authors should be applauded for performing a well-designed study regarding an important topic (e.g., acute pain) in patients undergoing plastic surgery.2,3 The need to reduce postoperative opioid consumption makes the topic very important in perioperative medicine.4,5

Nonetheless, there are several critical points that need to be clarified to determine the validity of the authors’ findings. First, it is unclear whether the authors validated their measurement of opioid consumption by using accepted methodologies such as “pill counts” or more sophisticated device technologies.6 Finally, it would be important for the authors to predict the patient and surgical factors that lead to opioid use after plastic surgery using a multivariate analysis. This would inform clinical practitioners on how to tailor their opioid-prescribing practices.

I would welcome comments to address the aforementioned issues, as they were not discussed by the authors. This would help to further support the findings of this important study.


The author has no financial interest to declare in relation to the content of this communication. No funding was provided.


1. Rose KR, Christie BM, Block LM, Rao VK, Michelotti BF. Opioid prescribing and consumption patterns following outpatient plastic surgery procedures. Plast Reconstr Surg. 2019;143:929–938.
2. Osaka Y, Morita Y. Supraclavicular brachial plexus block is an alternative to pectoral nerve block 1 for contracture reconstruction post mastectomy. J Clin Anesth. 2018;46:12.
3. Kelley BP, Chung KC, Chung TT, et al. Postoperative ketorolac in breast and body contouring procedures: A nationwide claims analysis. Plast Reconstr Surg. 2018;142:472e–480e.
4. Tong QJ, Lim YC, Tham HM. Comparing adductor canal block with local infiltration analgesia in total knee arthroplasty: A prospective, blinded and randomized clinical trial. J Clin Anesth. 2018;46:39–43.
5. Ueshima H, Otake H. Blocking of multiple posterior branches of cervical nerves using an erector spinae plane block. J Clin Anesth. 2018;46:44.
6. Tomko RL, McClure EA, Squeglia LM, et al. Methods to reduce the incidence of false negative trial results in substance use treatment research. Curr Opin Psychol. 2019;30:35–41.


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