Do doctors currently use Exparel? What are good and bad for using this product?

Question

I want to ask my Doctor about using this after my surgery. I know Doctors hate to hear a patient say the word google. So I want to know if this is still used after a tt.

Richard H. Tholen, MD, FACS · Answer

I have used Exparel in my practice for over a year now, and can tell you it does indeed reduce (but not eliminate) pain after breast or abdominal surgery. I know this by the reduction in calls asking for more pain medication or refills for post-op narcotic.Since I also use oral muscle relaxants (reduces muscle spasms), oral anti-inflammatory medication (reduces swelling), IV Decadron (reduces nausea, stabilizes cell membranes, reduces inflammation), my patients already use a minimal amount of their narcotic pain pills. I ask them to do this as well, as narcotics can increase post-op nausea and vomiting (PONV), not to mention giving you constipation.There's nothing like straining in the bathroom when you've had a tummy tuck or any kind of belly surgery! Count me among those who can attest to this personally!So, YES, I do indeed use Exparel, even though it is frightfully expensive. Feel free to ask your surgeon if he or she does. And why not? if they choose not to. The honest answer should be cost/benefit ratio.BTW, We don't "hate" to hear the word Google--I love well-prepared and informed patients! However, I am a bit surprised (and sometimes annoyed by the pushiest ones) by that minority of patients who feel they can learn in a few hours of internet research what took me 6 years of college (2 degrees), 3 years of medical school (no summers off), 5 years of General Surgery residency (Mayo Clinic), 2 years of Plastic and Reconstructive Surgery fellowship (Mayo Clinic), and 30 years of day-in, day-out experience to learn about my specialty. Questions are fine, and even after all that education I don't know everything, and am not embarrassed to say so. But I can pretty much guarantee that in most cases I DO know more about about most anything plastic surgery-related a patient can ask me, if he or she is willing to LISTEN to my answer rather than thinking about their next question to try to "stump the chump!"Also, Exparel is not magic. Careful surgery and meticulous hemostasis will always be better than rough or sloppy surgery and a "wonder drug." Just thought you should know. Best wishes! Dr. Tholen

Lawrence Iteld, MD · Answer

Exparel is a sustained release formulation of a local anesthetic, bupivicaine. When injected into the surgical site, patients typically see a reduction of pain for 36-72 hours. Physician experience and technique are critical to getting the best and longest acting results with Exparel.We have been routinely used Exparel for over 4 years and have noticed a dramatic reduction in patient discomfort after surgery, improved patient experience, and quicker return to work/ daily activity. Due to the current opioid epidemic facing our society, over the past 2 years, we have implemented a protocol which has all but eliminated the need for narcotic pain medications after breast augmentation, tummy tucks, breast lifts, mommy makeovers, and breast reduction. We feel that reducing the need for narcotics after surgery is essential and will continue to work toward this goal.

William T. Stoeckel, MD · Answer

Exparel is commonly used with tummy tuck surgery. It is a long lasting local anesthetic that provides some level of pain relied in the first few days after surgery. I have found that Exparel does indeed work, but the effectiveness varies from patient to patient. It does not completely eliminate pain and I do not think that it lasts as long as the manufacturer claims. My patients have reported decreased pain for about 2 days using Exparel, but not much more than that. The medication is injected into the fascia during the tummy tuck surgery and is usually not provided for patients after the surgery is completed.

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  Exparel is good at providing up to 72 hours of pain reduction for patients in the immediate postoperative period but it must be administered at the time of the surgery.  Costs will range in the $300 dollar per vial with typically one vial required for a tummy tuck.  Hope this helps.

Richard Baxter, MD · Answer

Exparel is very useful in reducing pain, lessening the need for pain pills, and reducing the side-effects of pills because you are using them less. Many surgeons now place the Exparel using a technique called a TAP block for tummy tucks, which seems to make it even more effective.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  My patients have had great experiences with exparel with significant pain reduction of up to 72 hours post surgery.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Samir S. Rao, MD · Answer

Exparel is a great long acting local anesthetic that can be injected during surgery which can last up to 72 hours.  I use it in abdominoplasty, cosmetic breast surgery, and breast reconstruction surgery (at hospitals where it is available).  In my mind the only downside is the cost, which is around $400 to the patient.  Most of my patients who get have noticeably less pain than those who don't not get it for the same procedures.

Janet Turkle, MD · Answer

Thanks for your question. Exparel is a timed release local anesthetic that is used frequently in many surgical specialties. Abdominoplasty patients find this very helpful in reducing the discomfort after the muscle repair component. Unlike the pain pump, there are no external tubes required. It is injected at the time of surgery.

Charles T. Slack, MD · Answer

I have used it on my tummy tucks and have seen a significant improvemnt in early post operative pain relief. I have not used it on breast surgery yet. It typically lasts 2-3 days but this is when pain is often the worst after surgery. The main downside is the cost. At my center they charge $300-$350 for the medicine other places are more. Accidental intra-vascular injection can cuase cardiac issues similar to receiving too much lidocaine. This is uncommon if the injector takes his/her time and uses proper injection technique.

Robert J. Paresi Jr., MD, MPH · Answer

Thanks for the question.  Yes, I use Exparel routinely in tummy tucks and cosmetic breast surgery.  It is excellent for controlling postoperative pain and decreasing the need for postoperative narcotics.  I have also found that patients return to normal activity much sooner when using the product.  It does have some additional cost but patients have been happy to pay for it.  Unfortunately, some hospital systems have prohibited the use of Exparel because of the additional cost but we offer the product at our own facility.

Do doctors currently use Exparel? What are good and bad for using this product?

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