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

Doctor Answers (47)

Alternatives to codeine for pain relief

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All narcotic pain relievers have some resemblance in their chemical structure, and an allergy to one can mean being allergic to others.

Many times when patients tell me they are allergic to codeine  it is not a true allergy, but rather a sensitivity, meaning they get nauseated or have some other side effect, rather than a rash, hives or other true allergic reaction. It is best to define this first, and then look at some of the alternatives, both narcotic and non-narcotic.

Although we have relied on the use of narcotic pain relievers for pain  since the Civil War, they have some negatives and some patients just don't tolerate them. Or, in the case of recovering addicts, they never want to touch them again. Does this prevent us from being able to do surgery because of inability to deal with the pain? Not at all.

There are non-narcotic alternatives available which may be sufficient with proper mental preparation and  good planning. 

Discuss this with your doctor at length and I am sure a good program me can be planned to give you peace of mind going into surgery


Vancouver Plastic Surgeon
5.0 out of 5 stars 11 reviews

Non-Narcotic Medication following Mommy Makeover

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Most of my patients do fine with non-narcotic medications and a pain pump. If you are very concerned about discomfort, you could have your mommy makeover performed in stages rather than all at once. 

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 42 reviews

Consider using a pain pump for post operative pain control

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Alternatives to codeine include oral Demerol and synthetic forms of morphine.  I usually place a pain pump and this greatly decreases post operative pain and discomfort.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 10 reviews

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Ultram & Double Strength Tylenol are Great Options

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Pain control is extremely important following cosmetic surgery. Patients frequently report allergies to various pain medications and as a result, pain management may require adjustment in the postoperative period.
Most patients who say they are allergic to codeine don’t have a true allergy. They usually have severe nausea, which codeine is notorious for causing.
We typically use a synthetic codeine derivative called Hydrocodone, which has a decreased incidence of nausea compared to codeine.
Examples of prescription Hydrocodone commonly used include Vicodan and Lortab. When these don’t work or patients are allergic to them as well, we use Ultram. We replace narcotic pain relievers with double strength Tylenol as soon as possible following surgery to avoid the potential for drug problems.
Pain tolerance varies from patient to patient and with appropriate care can usually be managed without difficulty. When allergies to pain medications occur, multiple alternatives exist to deal with this problem.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 89 reviews

Allergic to Codeine Pain Medications

+2

The allergy to codeine in pain medicines is so common that I rarely use these pain medications in my practice.  Artificial codeine, hydrocodone, is more commonly prescribed and used in products like Vicodin and Lortab and these medications are surprisingly effective on many individuals who cannot tolerate codeine but can tolerate hydrocodone.

Even when I have prescribed the hydrocodone medications, I encourage my patients to as quickly as possible to convert to anti-inflammatory medications like Advil, Nuprin and Motrin which are Ibuprofen products and Alleve which is a different anti-inflammatory product.  These medications actually effect the pain problem itself instead of hiding the symptoms in one's brain and have less side effects.

Never forget the use of ice and cold packs to reduce the amount of pain on almost all areas of the body following surgery.

John K. Long, MD
Houston Plastic Surgeon
5.0 out of 5 stars 4 reviews

Hydrocodone

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If you have an allergy to codeine, you can still take Vicodin or Percocet.  Both are very good narcotics for pain relief.  In fact I would use them instead of codeine in every case.

Gary Lawton, MD, FACS
San Antonio Plastic Surgeon
5.0 out of 5 stars 23 reviews

Pain control after mommy makeover

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There are several options for reducing discomfort after surgery. Patients most commonly use a narcotic oral medication but certain individuals are sensitive to narcotics with headaches, stomach distress, and constipation. Sometimes one narcotic may work better than another. My patients have had excellent response to dilaudid, especially when used along with valium to minimize muscle spasm and long acting local anesthetics. Discuss your concerns with your surgeon to find what solution will work best for your unique needs. 

Andrew Goldberg, MD
Fairfax Plastic Surgeon
4.5 out of 5 stars 4 reviews

Alternatives to Codeine and Narcotics

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If you cannot take Codeine or Narcotics, I recommend the use of Celebrex and Acetominophen (does not make you drowsy and less chance of nausea) plus intraoperative use of Exparel. Exparel is a very long-acting local anesthetic that lasts approximately 3 or more days following injection and great for Tummy Tucks and other surgeries. Not only does it prevent pain but also most muscle spasms. It lasts the same length of time that a pain pump lasts and will therefore take the place of a pain pump. This means patients can enjoy the same effect of a pain pump, but without any catheters and no pain pump to carry around.
Exparel will be available for those concerned about minimizing discomfort after surgeries such as tummy tuck and breast augmentation.
Exparel costs the same as a pain pump and produces the same result but with less hassle and works great.
Narcotics are used only as needed (as cause nausea, vomiting and constipation as frequent sided effects).

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 50 reviews

SPRIX

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One option for post-operative pain control is Sprix Nasal Spray or intra-nasal toradol.  Toradol is one of the most powerful NSAID's and has none of the negative side effects of opiate based pain medication (percocet/vicodin/norco) such as nausea, dizziness, constipation.  Ask your doctor if it is safe for you to try Sprix as a post op pain control medication.  NSAID's impact the clotting cascade and increase the risk of bleeding, hematoma, as well as gastritis.  

James H. Rosing, MD
Newport Beach Plastic Surgeon
5.0 out of 5 stars 5 reviews

Pain Control After Mommy Makeover

+1
What is your reaction to Codeine and what pain medications have you safely taken in the past?
If you have a sensitivity to Codeine (nausea, light-headedness, constipation), you may be fine with other narcotic pain relievers (Vicodin, Percocet, Demerol), especially if you have had no problems with them in the past.
If you have a true allergy (rash, hives, swelling, shortness of breath), you may also be allergic to other narcotic pain relievers. In this case, Tramadol may be a safe option.
No matter what you take for pain relief, I recommend a muscle relaxer as well. I also recommend placing a pain pump to supplement your medications. This is similar to an epidural in that catheters are placed in the surgical area. These catheters are attached to a reservoir which continually pumps local anesthetic into the surgical area for pain relief without narcotics and can be refilled. Another option is Exparel, which is a long-acting local anesthetic that is injected during surgery.
As you can see, there are a few good options for pain control. It's best to talk with your surgeon about your allergies and devise a plan that suits your needs.

Gabriel Chiu, DO
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 10 reviews

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