Which Do You Think is Better for Pain After a Tummy Tuck?

Question

I'm on methadone and am going to have a tummy tuck. For the post op pain management, I wanted to know which would better help with the pain, tramadol or the on q pain pump for 5 days?

Larry S. Nichter, MD, MS, FACS · Answer

The short answer is the On-Q pain pump works better. The long answer is that Exparel is a better choice.Essentially Exparel is a very long-acting local anesthetic that works great. It lasts approximately 3 or more days following injection. This is 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 plus decreases spasm of muscles after a tummy tuck.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. I use if in virtually all of my tummy tuck patients.

Vincent N. Zubowicz, MD · Answer

With a methadone history your postop pain management will be more complicated. I'm not a big fan of pain pumps but Marcaine injected into the fascia at the time of closing seems to help. Toradol is an excellent drug but can be given orally for only a brief time.

Mark D. Epstein, MD, FACS · Answer

I used the On-Q Pain pump for about 12 years or so before going to Exparel. I have been using Exparel for about 1 1/2 years now and there is no comparison. It is not uncommon for patients to require as little as only tylenol after surgery or a couple of narcotic pain pills the first day or two (and I mean a couple of pain pills!). Although the On - Q pump works, the degree of pain relief, in my opinion, as well as that of my recovery room nurses (becasue we have discussed this) is far, far better with Exparel.

Richard Baxter, MD · Answer

First, it is really best to have your pain management doctor involved. However, a good way to minimize your pain and therefore the need for medications is Exparel, a long-acting numbing agent that would be injected during surgery and lasts for up to 3 days. An On-Q works the same way except that it has an external reservoir and slowly infuses a numbing medication through small catheters.

David Shifrin, MD · Answer

Tramadol could also aid in pain control, but the pain pump is a great help in numbing the abdominal wall!

	 

	good luck

Tom J. Pousti, MD · Answer

Thank you for the question. Good pain control after tummy tuck is very important for many reasons. Besides the important concern of patient comfort, good pain control allows for better/easier deep breathing exercises and ambulation. These measures may lead to decreased incidences of pulmonary complications and/or thromboembolic phenomenon.These days plastic surgeons have many options when it comes to pain control after tummy tuck surgery. The use of narcotic medication, muscle relaxants, non-narcotics, pain control pumps, and long-lasting local anesthetics have made the postoperative experience much better than in the past. The specific medications used will vary from one practice to another.In our practice, all patients undergoing, tummy tuck surgery receive a postoperative pain control pump. I have yet to have a patient complain of the "hassle" factor. In my opinion, there is no demonstrable difference between the use of local anesthesia provided through a pain pump versus long lasting injectable anesthetics. There are certainly no objective studies that demonstrate the superiority of one over the other. Best wishes.

Barry L. Eppley, MD, DMD · Answer

With your medical history, you are best served by having Exparel injections done into the muscle during surgery for the first few days. Afterwards your after surgery pain management should be done by your pain management physician.

Karol A. Gutowski, MD, FACS · Answer

Have your pain management doctor involved. Multi-modality pain control is better than just one type of medication. Tramadol does not work for everyone but a combination of tylenol & an NSAID is a good way to start. The On Q pain pump or Exparel during surgery are also good and can be used in addition to the pills.

Jourdan Gottlieb, MD · Answer

There are two methods of providing extended local anesthetic--pain pump which gives about three days worth of marcaine, and can be refilled, and Exparel, which is injected during surgery and can give up to 3 days of pain relief, but can't be supplemented after that. It will be important for both you and your surgeon to be in touch with your pain doc. 

	All the best.

Remus Repta, MD · Answer

Hello,

	I have had a few patients on long term pain management who have undergone a tummy tuck.  It will be important in your case to have your plastic surgeon and your pain/addiction doctor discuss the best course of action.  Often, numbing medication is injected during the procedure (marcaine) and Percocet, Nucynta, and Sprix can be used as post op pain management.  I would discuss Exparel with your plastic surgeon as it may provide 24+ hour pain relief early on.

	All the best,

	Dr. Remus Repta

Which Do You Think is Better for Pain After a Tummy Tuck?

Answers (10)

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