Pain after plastic surgery is inevitable. However, it may not need to be as bad as you think - or as bad as you or your friends may have experienced elsewhere! Some procedures are more painful than others. The common procedures of tummy tuck (abdominoplasty) and breast augmentation with submuscular implant placement, are the two plastic surgery procedures that have the most postoperative pain. The good news is, there are some methods to minimize this pain and minimize the need for narcotics. I'll describe these methods after discussing narcotic pain relief.
Most patients having surgical procedures other than very minor surgery will need narcotics. These are common medications that you have taken or heard of such as Vicodin, Percocet, and Codeine. Other non-narcotic pain relievers may be combined with the narcotic ingredient, such as acetaminophen (Tylenol) with hydrocone to make Vicodin, or with oxycodone to make Percocet. The problem with narcotics is that they can have significant side effects: the most common ones include nausea, vomiting, constipation while the less common ones include dependence and abuse. Also, any added medication such as acetaminophen can add its own risks and the dose limits can easily be reached in someone who is having a lot of pain and taking a lot of pain pills.
The goal of minimizing the need for narcotics should be obvious. Multimodal therapy seeks to address the pain with more than just the traditional narcotic. Sometimes for example, Valium, in addition to its anti-anxiety effects, can also help relieve muscle spasm, indirectly helping reduce pain. Intravenous acetominophen (Ofirmev) is used on our general anesthesia cases and helps reduce post-operative pain. A local anesthetic can also be a huge help, but local anesthetics need to be applied continually, or else they wear off after a few hours. So let me discuss two methods of sustaining the effect of local anesthetics.
The first, pain pumps, have been used in numerous applications including orthopedic surgery and general surgery, and I have used them routinely in breast augmentation surgery for almost 8 years. I have used different models and brands, but basically the idea is that a reservoir of a non-narcotic local anesthetic such as lidocaine or bupivicaine is slowly pumped into the area of surgery through very tiny tubing, over about 48 hours. Once the reservoir is empty, the tubing is pulled out in the office. The pump has done its job, minimizing the pain and reducing the narcotic requirement over the first 48 hours when the pain is most significant.
The second method is newer, using a product that was FDA approved at the end of 2011 and released to market as of April 2012. I was actually one of the Principle Investigators on two of the clinical trials of the product, produced by the company Pacira. The product has been released as Exparel, and it releases bupivicaine into the surgical area over about 72 hours. The bupivicaine is held within microscopic liposomes that dissolve over that time and release the medication. The advantage over pain pumps is that the Exparel is applied once at the time of surgery, and needs no reservoir to be carried around or tubes that need to be removed.
Most procedures do not need pain pumps or Exparel. But there are procedures that will be much better tolerated with them! Namely, breast augmentation and abdominoplasty. I have routinely offered pain pumps to all my breast augmentation patients since 2004, but I will now be offering Exparel routinely to all breast augmentation and abdominoplasty patients.
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