What is the Impact of Analgesia Strategies on Postoperative Outcomes in Abdominoplasty: A Systematic Review and Meta-Analysis (Preprint)

BACKGROUND Abdominoplasty is common cosmetic surgery with considerable postoperative pain issues, traditionally managed using opioids, resulting in increased risks for addiction and postoperative nausea and vomiting (PONV). This research assesses the effectiveness of multimodal analgesia (MMA) methods—Regional Blocks (e.g., TAP blocks), Local/Regional Infusion (e.g., liposomal bupivacaine), and Nonconventional Opioid-Sparing strategies (e.g., celecoxib, ketamine)—on the severity of postoperative pain, opioid consumption, and PONV among abdominoplasty patients. A clinical algorithm with Regional Blocks prioritization is also proposed which offers a practical roadmap to opioid-sparing pain control. OBJECTIVE 1. To assess the effectiveness of multimodal analgesia (MMA) strategies in reducing postoperative pain, opioid consumption, and PONV in abdominoplasty. 2. To quantify the impact on pain intensity (SMD), opioid use (MD, MME), PONV (RR), and functional recovery. 3. To develop an evidence-based, opioid-sparing clinical algorithm prioritizing regional blocks. METHODS As per PRISMA guidelines, we searched Embase and PubMed (2005–2020) for randomized controlled trials and cohort studies comparing analgesia interventions (e.g., TAP blocks, liposomal bupivacaine, NSAIDs) with controls in abdominoplasty patients. The inclusion criteria were opioid use (morphine milligram equivalents, MME), PONV rate, or data for pain scores. RESULTS 29 studies (1174 patients) from 500 records were included. The pain intensity (19 studies, 1092 patients) decreased significantly (standardized mean difference [SMD] = -1.78, 95% CI: -1.95, -1.61; I² = 68%, p < 0.0001). Opioid consumption (22 studies, 1174 patients) fell by 10.23 mg MME (mean difference [MD] = -10.23, 95% CI: -12.07, -8.39; I² = 98.2%, p < 0.0001). PONV risk (902 patients, 10 studies) decreased by 32% (risk ratio [RR] = 0.68, 95% CI: 0.56, 0.84; I² = 0%, p = 0.9810). Best reduction of pain was achieved using regional blocks, opioid sparing through local/regional infusion, and nonconventional methods with PONV prophylaxis with sensitivity analyses confirming robustness. CONCLUSIONS MMA (preoperative TAP blocks, intraoperative liposomal bupivacaine or infusion, postoperative NSAIDs/ketamine) enhances recovery, reduces opioid dependence, and enhances satisfaction in abdominoplasty. Limitations include heterogeneity of opioid data and limited nontraditional studies, with implications for standardized protocols and larger studies to examine patient-specific variables and long-term outcomes.