I am a 36 y.o. I'm going in on February 24th for a mommy make-over. I vomit every time I try narcotics, suggestions?

Question

I have tried Tylenol with codeine, Percocet and Tramadol at one time or another and each and every time I get nauseated and vomit. I've spoke with my surgeon regarding this, but I'm looking for other tips, tricks, opinions to control pain and prevent these unwanted side effects immediately post-op and while at home recovering. Suggestions please?

Vincent N. Zubowicz, MD · Answer

Narcotics are a mainstay of significant postoperative pain. There are however other alternatives with fewer side effects such as nausea that can be employed.

William T. Stoeckel, MD · Answer

You have several options of things that might minimize both your pain and nausea after surgery. The first would be to minimize anesthesia medications that induce nausea. I complete all of my surgeries using only IV medications for anesthesia. Avoiding a true general anesthetic and the inhalation agents used can almost completely eliminate post op nausea. Anesthesia providers that use this type of anesthesia know that it can be done safely, but those that don't will claim that it can't be done for a full abdominoplasty and breast surgery. I have been using this type of anesthesia throughout residency and now 6 years into my private practice and wouldn't do it any other way now. Patients wake up and feel normal very quickly and the nausea complaints are extremely rare. The next thing would be to consider using a long acting local anesthetic like Exparel. This medication can be injected into the abdominal wall fascia before the closure is completed on the tummy tuck and can also be used on the chest wall fascia with breast surgeries. It can provide about 48 hours of relatively impressive pain relief that will minimize, if not eliminate, the need for narcotics in the early recovery period when the pain is the worst. Another option would be to utilize a pain pump of some type that delivers a constant drip of local anesthetic for the first 2-3 days after the procedure. These options will add an additional cost to the procedures, however. The other thing to consider is making sure that you have an anti-nausea medication that can be taken along with the narcotics, if you need them. There are several anti-nausea medications that work for this purpose.

Christopher J. Morea, MD · Answer

Schedule an appointment or ask to speak with the anesthesia provider who will be caring for you.  Emend is a medication that works very well if taken prior to surgery.  A scopolamine patch applied prior to surgery is also very effective in preventing post op nausea.  Always take your oral pain medication with food.

Richard Baxter, MD · Answer

For nausea related to anesthesia, there is nothing more effective than Emend, but it must be taken prior to the procedure. Zuplenz works well as a rescue medication. Exparel is a long-lasting numbing agent that reduces the need for narcotic meds by about 50% on average in my experience.

David Janssen, MD, FACS · Answer

There are several answers. Patients can get all sorts of medicines and still get sick. Avoiding nausea as you're waking up is important. TIVA Total Intra Venous Anesthesia avoids the use of gasses and helps immensely. Drugs like Emend (expensive) Zofran (works ok) Scopolamine (also works pretty good) are used but have their own problems. Using indwelling pain pumps and Exparel (3 day long lasting local) add to cost but can preclude use of Narcotics. I have lots of patients like you that I use Tramadol with Celebrex (as an off label use of a FDA arthritis drug) that works great too.

Robert E. Zaworski, MD (retired) · Answer

Discuss this with the anesthesia department prior to your surgery.They have IV meds that they can give you to help with nausea.  Also, take narcotics with food, and not on an empty stomach.  Best wishes for your surgery!

I am a 36 y.o. I'm going in on February 24th for a mommy make-over. I vomit every time I try narcotics, suggestions?

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