Enhanced Recovery After Lipoabdominoplasty Under Sedation, Transversus Abdominis Plane Block, and Tumescent Anesthesia: Patient Expectations and Experience in the Early Postoperative Phase.

Abstract

Patients' preoperative fears and expectations may help explain why lipoabdominoplasty is overwhelmingly performed under general anesthesia rather than sedation. The aim of this study was to evaluate concordance between preoperative expectations and early postoperative recovery and to assess whether fear of intraoperative pain may explain a preference for general anesthesia over a sedation-based regimen. Single-center, prospective cohort of consecutive outpatients undergoing lipoabdominoplasty (December 2020-June 2025). All procedures used intravenous sedation, tumescent local anesthesia, and a transversus abdominis plane (TAP) block. Demographic data were collected, surgical outcomes were assessed using the BODY-Q questionnaire, and patient-reported anxiety and anesthetic expectations before and after surgery were evaluated with the International Pain Outcomes (IPO) questionnaire. In addition, patient expectations regarding the resumption of daily activities were systematically compared with the actual timelines of their achievement. Thirty-nine patients were included (87% female; mean age 37 ± 11 years; BMI 26.0 ± 3.7 kg/m2). Preoperatively, 56% anticipated intraoperative pain, 28% nausea, and 26% loss of control under anesthesia. Postoperatively, all anesthesia-related concerns were significantly reduced from a median of 3 (4-2) to 1 (1-1) on a scale of 1 to 5. Within 72 h after abdominoplasty, patients typically resume indoor ambulation and stair climbing by Day 1, independent dressing and showering by Day 2, and a brief outdoor walk and preparing a small meal by Day 3. Intravenous sedation with tumescent anesthesia and TAP block met or exceeded preoperative expectations for intraoperative comfort. The median time to resume activities was slightly shorter than anticipated, and anesthesia-related fears-especially intraoperative pain-proved largely unfounded.