46 THE QUEENS COURIER • HEALTH • OCTOBER 26, 2017 FOR BREAKING NEWS VISIT WWW.QNS.COM
health
New pain control regimen shortens
hospital stay after reconstruction surgery
A researcher at Northwell Health’s
Feinstein Institute for Medical Research
has a new approach to help patients
recover faster from microsurgical breast
reconstruction while avoiding the need
for narcotic medications aft er surgery.
Opioid addiction has grown to epidemic
proportions in the United States
and most commonly starts with misuse
of prescription drugs. Two million
Americans suff er from opioid use disorder
involving prescription medications
while more than 20,000 deaths annually
are attributed to opioids, causing the
National Institute of Health to adopt “an
all hands on deck” approach to dealing
with the crisis.
Considering these facts, and knowing
the side eff ects of taking opioids,
Mark L. Smith, MD, vice-chair of the
Department of Surgery at Northwell
Health and director of reconstructive
oncology at Northwell Health Cancer
Institute, was driven to fi nd an alternative
to the mainstay of postoperative
pain control – intravenous and oral opioids.
“By substituting non-steroidal, anti-infl
ammatory medication for opioids and
using long-acting nerve blocks that work
locally to minimize pain at the surgical
site, our patients not only had less
pain, but avoided the eff ects of opioids
like grogginess and nausea. Th is allowed
them to get up and walk sooner and
leave the hospital on their second day
instead of the national average of four to
fi ve days,” said Dr. Smith. “Our patients
are pleased to be back to their lives more
quickly and relieved not to deal with opioid
side eff ects or risk of dependence.”
Dr. Smith and his team found they
could eff ectively block postoperative pain
by using a combination of anesthetic
injections, including a technique called
“transversus abdominis plane block,” or
“TAP block.” Th e drug they used for
the injections, liposomal bupivacaine, can
provide local pain relief for two to three
days, when pain is typically greatest.
Although a number of papers have
shown the effi cacy of liposomal bupivacaine
in providing long-term analgesia
for various nerve blocks, at this time
it is still only approved by US Food and
Drug Administration for direct injection
into wounds.
Breast reconstruction with abdominally
based fl ap surgery is an alternative to
using implants – it involves micro-surgically
transplanting fatty tissue from
the lower abdomen to the breast region
to create a new breast mound. Many
women prefer to use their own tissue
for reconstruction to avoid implants and
their potential long-term complications,
but are concerned about the recovery
aft er abdominal surgery.
“Aft er facing breast cancer and a double
mastectomy, I didn’t want to also
confront the side eff ects of opioids or
the potential of being dependent on opioids,”
said Lynn Bertsch, of Plainview,
NY, and patient of Dr. Smith. “I thought
it was important to my recovery to not
be in a fog – I wanted to drive – and
I wanted my body to feel healthy and
clean. My recovery exceeded my expectations.
My pain was completely manageable
and by the time I was itching to
get home, I was there sitting up in my
favorite chair and even walking around.”
Hospitals that are trying the new
pain regimen and seeing benefi ts for
their patients include Long Island
Jewish Medical Center in New Hyde
Park, Southside Hospital in Bay Shore,
Huntington Hospital, North Shore
University Hospital in Manhasset and
Staten Island University Hospital. Dr.
Smith, who presented his fi ndings at the
annual meetings of American Society of
Plastic Surgeons and the World Society
of Reconstructive Microsurgery, hopes
that his fi ndings will encourage other
doctors to examine the use of long-term
blocks to improve outcomes and that his
research will help hasten FDA approval
of liposomal bupivacaine for nerve
blocks.