The role of methocarbamol and intercostal nerve blocks for pain management in breast augmentation.

[BACKGROUND] Breast augmentation is one of the most common plastic surgery procedures performed in the United States. The optimal approach to postoperative pain management has yet to be determined.

[OBJECTIVE] The objective of this study was to investigate the efficacy of intercostal nerve blocks and oral methocarbamol for postoperative pain control.

[METHOD] One hundred primary breast augmentation patients were randomized to 1 of 4 treatment groups: (1) methocarbamol given with intercostal blocks, (2) methocarbamol given without intercostal blocks, (3) no methocarbamol given with intercostal blocks, and (4) no methocarbamol or intercostal blocks given. The patients and recovery room nurses were strictly blinded to treatment group assignment.

[RESULTS] All patients underwent primary augmentation with no other procedures performed. Patients who received intercostal nerve blocks required the same amounts of postoperative narcotics as those who did not receive blocks. Their mean visual analog scale (VAS) pain scores also did not differ significantly from those who received blocks. Patients who received preoperative methocarbamol had significantly lower VAS pain scores in the first hours after surgery than did those who did not receive the drug (P = 0.03).

[CONCLUSIONS] This study suggests that intercostal nerve blocks do not significantly decrease postoperative pain following breast augmentation. Preoperative use of methocarbamol may be of benefit to help diminish early perioperative pain. In this outpatient cosmetic surgery population, expeditious pain management with minimization of nausea and sedation is critical. A preoperative dose of methocarbamol may be of benefit and merits further investigation.