RESUMO
BACKGROUND: Suction-assisted lipectomy is one of the most common procedures performed in plastic surgery. To minimize blood loss and to obtain adequate analgesia, a liquid solution is infiltrated into the subcutaneous plane before suction. The objective of this study was to determine whether the use of lidocaine in the infiltration solution reduces postoperative pain. METHODS: A prospective, randomized, double-masked, clinical trial was designed. Each side of patients' body zones to be treated with suction-assisted lipectomy was randomized to receive infiltration solution with or without lidocaine. Treatment allocation was performed using computer-generated random numbers in permuted blocks of eight. Pain was assessed using the visual analogue scale and registered 1, 6, 12, 18, and 24 hours after the procedure. RESULTS: The trial was stopped after a first interim analysis. The use of lidocaine in the dilute solution reduced pain by 0.5 point on the visual analogue scale (95 percent CI, 0.3 to 0.8; p<0.001). The effect was independent of the suctioned body zone (p=0.756), and lasted until 18 hours after surgery. Its analgesic effect was lost at the 24-hour postoperative control. Pain increased an average of 0.018 point on the visual analogue scale per hour (95 percent CI, 0.001 to 0.036; p=0.043). CONCLUSIONS: The use of lidocaine in the infiltration solution is effective in postoperative pain control until 18 hours after surgery. Nevertheless, its clinical effect is limited and clinically irrelevant, and therefore it is no longer used by the authors. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.
Assuntos
Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Lipectomia/métodos , Dor Pós-Operatória/prevenção & controle , Adolescente , Adulto , Anestesia Geral/métodos , Intervalos de Confiança , Método Duplo-Cego , Feminino , Humanos , Injeções Intralesionais , Cuidados Intraoperatórios/métodos , Lipectomia/efeitos adversos , Masculino , Medição da Dor , Estudos Prospectivos , Valores de Referência , Medição de Risco , Resultado do Tratamento , Adulto JovemRESUMO
The extensive list of treatments for the nasolabial area illustrates that the problem is not solved yet. Although a better understanding of the anatomy and physiology of the nasolabial area has been developed, the ideal treatment has not been found. It seems that a combined approach based on summation of partially effective modalities is the best option. The authors present their experience with combined deep plane rhytidectomy, malar fat lift, and superficial musculoaponeurotic system graft in the treatment of the aging nasolabial area. Results in 70 consecutive patients are presented with this simple, nonscarring, inexpensive technique.