I Am Allergic to Codeine. Any Suggestions for Pain Control After Mommy Makeover?

For patients who are allergic to Codeine, it is first important to know what type of reaction the patient has.  In many cases, it would be acceptable to use Vicodin or Percocet as alternatives. Ultram is another alternative for patients who have had severe reactions to Codeine.  My favorite, however, is the new local anesthetic called Exparel that I inject along the incision lines at the end of a surgical procedure. This new anesthetic last for three days rather than a few hours.  It is extremely helpful at diminishing the need for oral analgesics and is associated with fewer side effects.

We discuss pain management in clinic before the surgery in details . If you are allergic to codeine, the anaesthetist will discuss your options and might prescribe you tramadol type of pain killers in conjunction with paracetamol and ibuprofen. For good pain relied, you need to take regular painkillers.

Great question. Post operative pain is one of the most important comments of a successful surgery. When pain is well controlled patients feel better, they get better sleep, feel more rested, they move around more easily, and get back to every day life more quickly. It also has been shown to decrease complications! As such we take pain control very seriously.
We utilize a concept called enhanced recovery protocol. Narcotics (such as codeine) only represent on small aspect of pain control, and fortunately there are many alternative available if we encounter patient allergies. This multimodal approach treats pain at several different targets within the body.
We start in the OR by performing a nerve block on the abdominal wall with a long acting numbing medication. This will provide on average 3 days of pain relief and it starts before the surgery is even done. It has been a total game changer for our patients! We then add Tylenol and a nonsteroidal anti-inflammatory (think of ibuprofen or Advil). These help reduce inflammation and add a baseline of pain control. Next we use gabapentin, which directly affects the nerves to decrease the level of pain. Then we add in a muscle relaxer, especially for patients that have the abdominal wall muscles tightened. As this is often an under appreciated cause of pain. Finally, we use a narcotic for any “breakthrough” pain. Our patients have generally been off narcotics within the first few days of surgery.
This whole concept steadily gained popularity for a couple reasons. First and foremost, many clinical studies have shown improved patient outcomes and decreased complications. So good pain control can help make our surgeries even safer! But secondly, our patients have been wanting to minimize the amount of narcotics they take. This approach has also been shown to decrease amount of narcotics patients take after surgery. The opioid epidemic has really made this more important for our patients.
So whatever the reason for avoiding narcotics, (allergies, fear of addiction, unpleasant side effects) we have been able to treat post operative pain with great success while also minimizing or eliminating narcotics!