Do you recommend your patients to take Emend anti-nausea medication on the morning of facelift surgery?

Question

I have usually been prescribed Zofran for after surgery nausea but some members of the facelift forum advise taking Emend tablet on the morning of surgery? It is VERY expensive at $150 for one pill and is not covered by my insurance. Surely the anti nausea meds in the IV during surgery, and the aftercare meds like Zofran will be enough? I did not feel nauseous after a previous bleph and rhinoplasty 10 years ago. Thanks in advance!

Marco Carmona, MD · Answer

It`s definitely not necessary to use or take this medicine before a facelift surgery. In my experience  the use of Zofran is absolutely enough to control nausea. It`s very important that you consult with your plastic surgeon whether you should or should not take this medicine before the surgery. I hope this was helpful.

Arthur Dean Jabs, MD, PhD, FACS · Answer

Stick with what has worked for you and the recommendations of your surgeon and anesthesiologist. Newer more expensive meds are not necessarily worth the money. If Zoran has worked for you ask for it again. The anesthesiologist is your friend.
Best of Luck,
Dr. J
A. Dean Jabs M.D. Ph.D. FACSBoard Certified Plastic Surgeon

David W. Rodwell III, MD · Answer

Emend is a wonderful option that is unknown to many doctors.  You should know that it works in a completely different way than the medications we typically use to treat nausea. I have used it with very good success.  However, it is costly.  For most patients the standard medications such as IV Zoran at the time of surgery are adequate.  I find that promethazine (Phenergan) is a more potent option as an oral pill to take after surgery (if needed) when compared to oral Zofran.Emend is an option that I use for patients who have a strong history of problems with nausea and vomiting after surgery.  There are patients out there who are particularly sensitive to prolonged post-operative nausea and vomiting.  For these people I find that Emend in addition to other medications is worth the relatively small additional cost.

Jed H. Horowitz, MD, FACS · Answer

Facelift surgery and nausea

here are some of our recc.   Emend is given to patients with severe hx of nausea who do not do well with other meds  ..  See the cross activity on medications

1 day before surgeryScopolomine patch (nausea) Place on upper arm the day of surgery.Day of Surgery Antibiotic – only three pills required (preventative only) If you are having your surgery in the office please eat a light breakfast and take your firstpill with breakfast the day of surgery. Proceed to take the next pill the evening of yoursurgery and the last one the following morning. If you are having your surgery at a surgery center (Talbert or HSC) please begin takingthe antibiotic after surgery with food at dinner time. You will then take the second pill thefollowing morning and the last one the following evening. Aprepitant (EMEND) (nausea) Take with a sip of water 1-3 hours prior to surgery. If taking birthcontrol pills, also use additional contraception for 28 days. Note: This medication costsapproximately $60 but worth it. Celebrex (Pain/Swelling) Take 2 pill (200mgs) with a sip of water upon awakening on the day ofsurgery. Zofran Take 1 pill by disolving on the tongue the morning of surgery. Ativan (oral sedative) Please bring the prescription of Ativan with you on the day of surgery. It will beadministered to you by the staff.After Surgery Norco (pain medication) You can begin taking your pain medication once home from your surgeryand may continue to take one pill every 6-8 hours as needed for pain relief. Zofran (nausea) Take one pill every 8-12 hours as needed for nausea (this medication melts underyour tongue). DO NOT TAKE IF YOU ARE ON ANTI-DEPRESSANTS. Periactin (nausea) Take one pill 3 times per day while taking pain medication or if nausea persists. Flexeril (muscle relaxant) Take one pill 3 times per day for 5 days beginning the day after surgerywhen you start eating. Celebrex (pain/swelling) Take one pill every 12 hours. Do Not take with other anti-inflammatorymedications. Sclopolomine patch Remove after 3 days, then wash hands immediately after removal. Clonodine patch Remove 7 days after application

Michael I. Echavez, MD · Answer

Nausea after a facelift, or any cosmetic procedure, is normally caused by certain types of anesthetics that are used during the procedure.  With the type of anesthesia that I normally use for a facelift, patients normally do not have any nausea after the procedure and I do not routinely prescribe any anti nausea medications.  I would discuss this issue with your particular surgeon to see if you even need an anti nausea medication for your procedure.

David Janssen, MD, FACS · Answer

I love the drug Emend for people with a history of Postop Nausea and vomiting. We get the pills from a pharmacy and give them  as a single pill taken before our patients come in. It costs us 95.00 per pill. We only use 1. Along with the ERAS (Enhanced Recovery After Surgery) protocols, and great local, we try to avoid narcotics. I do not use Emend on everyone, but it works incredibly well.

Julio Clavijo-Alvarez, MD, MPH, FACS · Answer

Thanks for sharing your question. I can appreciate your concern.

Emend is a latest generation of antiemetic. It is very effective and costly. If you have had success with zofran in the past, I do not see why to change now.

Finally, make sure that you have a consultation with a board certified plastic surgeon.

Wishing you the best in your journey

Jacob D. Steiger, MD · Answer

Nausea is very uncommon after facelift surgery. There is a lower incidence of nausea when having a facelift under IV sedation rather then general anesthesia. However, even pain medication can give you nausea. Nausea is good to avoid because vomiting after surgery can potentially increase swelling and/or the chances for a hematoma. Most surgeons will give you zofran to take just in case you experience nausea after surgery. We give our patients a dose during surgery in order to help prevent this. We rarely have anyone complain of nausea after surgery.

Barry L. Eppley, MD, DMD · Answer

Emend is a great drug for those patients who have a known history of refractory nausea and vomiting from prior surgery that did not respond well to traditional drug treatments. Your prior surgeries does not show this to have been a problem in the past.

Lily Lee, MD · Answer

I am a big proponent of preventing post op nausea. It feels terrible and frankly wretching is the last thing you need after surgery. A lot of it will depend on what kind of anesthesia you had before and what kind you will have this time. Nausea is much more common with general anesthesia compared with conscious sedation. I have had a lot of success with the scopalomine patch that I have patients put on 24 hours before surgery. It is much cheaper than Emend!

Do you recommend your patients to take Emend anti-nausea medication on the morning of facelift surgery?

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