Advanced Surgical Pain Relief

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 acetaminophen (Ofirmev), or more recently, pre-operative oral acetaminophen, is used on our general anesthesia cases and helps reduce post-operative pain. Toradol, a non-narcotic pain reliever commonly used after many surgeries including orthopedic and general surgery procedures, is often used during anesthesia to minimize post-operative pain, and minimize the need for nausea-causing narcotics.
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 method, pain pumps, has been used in numerous applications including orthopedic surgery and general surgery. I used them routinely in breast augmentation surgery for almost 8 years. I 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. Pain pumps are cumbersome, however, with a reservoir to carry and tubes going into the surgical site.
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 Principal Investigators on two of the clinical trials of this product, produced by the company Pacira. The product was 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. The disadvantage is that it (and pain pumps) is expensive. I do offer Exparel for an additional fee. It is not necessary for most procedures, but there are procedures that will be better tolerated with Exparel, namely breast augmentation and abdominoplasty.

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Pacific Plastic Surgery
1722 State St., Ste. #102
Santa Barbara, CA 93101
Call Us 805.898.0700