All physicians are involved in the management of pain at some level or the other, but of the various specialties and health professions, surgeons are at the frontline of delivering perioperative pain care. Perioperative Pain Management for General and Plastic Surgery offers a concise yet comprehensive overview of the surgical pain management field to help practitioners effectively plan and enhance perioperative pain control. Chapters provide guidance on solving common dilemmas facing surgeons who are managing patients with pain related problems and clinical decision-making, and explore essential topics required for the trainee and practitioner to quickly assess the patient with pain, to diagnose pain and painful conditions, determine the feasibility and safety of surgical procedure needed, and arrange for advanced pain management consults and care if needed. This text also explores the latest evolving techniques and appropriate utilization of modern equipment and technology to safely provide care. Highly accessible and written by experts in the field, Perioperative Pain Management for General and Plastic Surgery is an ideal resource for practicing surgeons, anesthesiologists, critical care personnel, residents, medical students.

According to the Centers for Disease Control and Prevention (CDC), there were nearly 40,000 opioid-related deaths in the U.S in the last year alone. These numbers have increased considerably for a variety of reasons, and the growing role of prescription drug abuse has been widely recognized. There has also been increasing consciousness of the lack of dedicated and formalized training dedicated to prescription of analgesics, particularly among surgical trainees and practicing surgeons. Recent studies demonstrate that only a small minority of training programs mandates any opioid prescribing education, despite the fact that nearly all programs allow trainee prescription of opioids on an outpatient basis. Therefore, it is not surprising that despite a growing body of literature illustrating the value of opioid alternatives and adjuncts, practicing surgeons in all specialties largely ignore these evidence-based practices and continue to prescribe opioids in situations for which alternatives are proven, safe, and effective. There are many reasons for preparing a concise and practical resource describing evidence-based practices targeting surgeons and surgical subspecialists, including but not limited to: (1) The exponential increase in prescription drug abuse associated with the “opioid epidemic,” as surgeons play an important role in managing perioperative and chronic pain in a variety of practice setting; this issue bears importance from the patient, physician, and policymaker standpoint; (2) With increasing recognition of the role of quality improvement in patient safety initiatives, and literature demonstrating inadequate opioid prescribing education (OPE) in surgical training programs, it is only a matter of time before accreditation bodies including the ACGME incorporate strong recommendations and mandates for OPE; (3) Myriad literature demonstrating the existence of evidence-based alternatives to opioids – All surgeons and surgical subspecialists would benefit from a practical guide concisely laying this literature out. We feel that surgeons of all experience levels may benefit, ranging from the first year surgical intern to an experienced practitioner trying to remain compliant with the evolving opioid regulatory environment. Hence, the appropriate target audience for this text would be for the tens of thousands of current surgical trainees in many specialties, including general surgery, thoracic surgery, otolaryngology, plastic surgery, urology, gynecology, vascular surgery, neurosurgery, and orthopedic surgery. Furthermore, surgeons out of training would be another audience of interest, as there are increasing courses for continuing medical education based on perioperative and chronic pain management. Currently, there are no comparable and competitive guides with these target audiences; all of the existing literature about perioperative and chronic pain is targeted either specifically for patients, anesthesiologists, or pain medicine physicians. This will be the only up to date guide focusing on evidence-based practices for perioperative pain control, and each section will also include information on chronic pain sequelae relevant to each surgical specialty. The editors envision this text being an interdisciplinary endeavor, incorporating surgeons from multiple specialties, anesthesiologists, pain medicine physicians, and palliative physicians as appropriate.

This issue of Clinics in Plastic Surgery, guest edited by Drs. Michael W. Neumeister and Reuben A. Bueno Jr., is devoted to Pain Management in Plastic Surgery. Articles in this important issue include: Pain Pathways and Management in Plastic Surgery; The Opioid Epidemic; Principles of Pain Management in Plastic Surgery; Epidemiology and Treatment of Chronic Generalized Musculoskeletal Pain; Pediatric Pain Management in Plastic Surgery; Enhanced Recovery After Surgery (ERAS); Imaging of Damaged Nerves; Ischemic Pain; Nerve Entrapments; Neuromas; Targeted Muscle Reinnervation; Migraine Surgery; Complex Regional Pain Syndrome; Regenerative Peripheral Nerve Interfaces; and Postoperative Pain Management in Hand and Upper Extremity Surgeries.

Most patients who undergo cosmetic surgery do not report pain during the immediate postoperative period. However, most patients who underwent liposuction combined with or without other plastic surgical procedure suffer pain after surgery. There are three main techniques in acute pain management postoperatively which are systemic analgesia, regional analgesia, and local/topical analgesia, and these are the extent of trauma during the procedure, surgeon,Äôs skill, prior disease, location and type of incision, and psychological and cultural factors. Treatment for each type of plastic surgery and the resulting pain require techniques that can be used as single method or combined with each other to relieve postoperative pain after plastic surgery. Nausea, vomiting, constipation, somnolence, etc., are well-known adverse effects of opioids. Although these effects may seem minor, they can lead to significant complications following some type of plastic surgeries, for example, face-lift hematoma following nausea and vomiting, pulmonary complications from respiratory depression, and even thromboembolic phenomena from bed rest following prolonged opioid use. Multimodal pain management has been documented to increase patient satisfaction and reduce both opioid use and the incidence of PONV.¬†Combination of pain management in plastic surgery included patient-controlled analgesia intravenous (PCA-IV), patient-controlled epidural analgesia (PCEA), patient-controlled regional analgesia (PCRA), field block (TAP block), continuous wound infusion system using pain pump and tumescent analgesia with local anesthetics.

This book presents the essential steps involved in diagnosing and treating pain due to peripheral nerve injury and compression. In the first chapter, the relevant anatomy and diagnostic tools to identify peripheral-nerve-related issues are described. The main part of the book, however, deals with the surgical techniques to address specific types of peripheral nerve pain, e.g. neuroma, thoracic outlet or migraine. A step-by-step, practical approach is provided, including important aspects to consider both pre- and post-op. The procedures presented are minimally-invasive and maximally effective. Each chapter features detailed surgical illustrations and anatomical images. Chronic pain control is a growing need and minimally invasive yet effective surgical techniques, combining the competences of neurosurgery, plastic surgery, orthopedics, general surgery, pain management and neurology are in high demand. The increasing demand on the part of patients suffering from neuropathic pain is to date not matched by adequate practical training in peripheral nerve surgery to control pain. The authors are experts in this discipline “from head to toe” and present a valuable guide that provides medical students and experienced clinicians alike with useful information for their daily practice.

All physicians are involved in the management of pain at some level or the other, but of the various specialties and health professions, orthopedic surgeons are at the frontline of delivering perioperative pain care for a wide variety of problems that range from skeletal trauma, joint replacement procedures, bone tumors and spinal conditions. Perioperative Pain Management for Orthopedic and Spine Surgery offers a concise yet comprehensive overview of the surgical spine pain management field to help practitioners effectively plan and enhance perioperative pain control. Chapters provide guidance on solving common dilemmas facing surgeons who are managing patients with pain related problems and clinical decision-making, and explore essential topics required for the trainee and practitioner to quickly assess the patient with pain, to diagnose pain and painful conditions, determine the feasibility and safety of surgical procedure needed, and arrange for advanced pain management consults and care if needed. This text also explores the latest evolving techniques and appropriate utilization of modern equipment and technology to safely provide care. Highly accessible and written by experts in the field, Perioperative Pain Management for Orthopedic and Spine Surgery is an ideal resource for practicing orthopedic and spine surgeons, anesthesiologists, critical care personnel, residents, medical students.

All physicians are involved in the management of pain at some level or the other, but of the various specialties and health professions, orthopedic surgeons are at the frontline of delivering perioperative pain care for a wide variety of problems that range from skeletal trauma, joint replacement procedures, bone tumors and spinal conditions. Perioperative Pain Management for Orthopedic and Spine Surgery offers a concise yet comprehensive overview of the surgical spine pain management field to help practitioners effectively plan and enhance perioperative pain control. Chapters provide guidance on solving common dilemmas facing surgeons who are managing patients with pain related problems and clinical decision-making, and explore essential topics required for the trainee and practitioner to quickly assess the patient with pain, to diagnose pain and painful conditions, determine the feasibility and safety of surgical procedure needed, and arrange for advanced pain management consults and care if needed. This text also explores the latest evolving techniques and appropriate utilization of modern equipment and technology to safely provide care. Highly accessible and written by experts in the field, Perioperative Pain Management for Orthopedic and Spine Surgery is an ideal resource for practicing orthopedic and spine surgeons, anesthesiologists, critical care personnel, residents, medical students.

Millions of procedures, surgical and non-surgical, are performed around the world each year. Management of perioperative pain is of great importance to patients, and a critical management issue for physicians and other health professionals who provide perioperative care. Healthcare facilities and national accrediting organizations have established standards surrounding proper management of perioperative pain. There is now an increased burden on every hospital and training program to ensure that healthcare providers understand the essentials of pain management and are able to recognize and treat pain in a timely fashion. Poorly controlled pain leads to patient dissatisfaction and contributes to increased morbidity and mortality, such as myocardial infarction, pneumonia, and emotional effects. Proper management, including appropriate pharmacologic management and regional analgesic techniques, can improve function and shorten length of hospital stay. Patients who are undergoing procedures under sedation or anesthesia need to receive adequate pain relief with drugs or regional anesthetic techniques. In the recovery room following the procedure, the staff taking care of the patient needs to be properly trained to diagnose and treat post-procedural pain. Part of the Oxford American Pain Library, this concise, evidence-based clinical guide serves as a tool for every clinician who wishes to understand the basic mechanisms, pharmacology, invasive and noninvasive treatment modalities, guidelines and development of pain management protocols. The authors address new technologies, chronic pain issues, running an acute pain service, opioid and non-opioid pharmacology (including newly approved drugs), epidural and other regional anesthesia, and special populations such as pediatric patients, the elderly, and patients with a co-existing disease.

Currently, two-thirds of patients undergoing surgery experience acute postoperative pain (POP), which increases the possibility of immediate postoperative complications and facilitates the development of chronic POP. Post-surgical pain does not have a useful biological function, so it must be prevented, avoided, and/or eliminated. The objective of the rational management of acute pain after surgery is to facilitate the rapid recovery of patients with a prompt integration into their usual preoperative activities. The global crisis of opioid abuse has forced us to use other analgesic drugs as well as regional analgesia techniques that are part of effective multimodal analgesia. The non-pharmacological approach has also gained importance in the comprehensive management of acute POP. This book reviews advances in the understanding, management, and complications of POP.

Plastic and reconstructive surgery has evolved over the last two decades, with advances in anesthesiology, pharmacology, perioperative medicine, and novel monitoring devices contributing significantly to these patients being able to recover and live safely. Patients with chronic pathologies such as diabetes, hypertension, heart disease, obesity, chronic obstructive pulmonary disease, congenital or trauma injuries, changes due to excessive weight loss and others, as well as patient-tourists who have traveled enormous distances are now able to receive cosmetic and reconstructive surgeries that in the past were rejected. The authors of this book also discuss various contemporary topics of anesthesia for plastic and reconstructive surgery that are especially interesting and controversial due to the latest developments on this subject.