My tummy tuck is in two weeks. Exparel vs pain pump?

Question

My tummy tuck is in 2 weeks and my ps uses pain pump. However I heard that exparel works better for pain control and I would like him to use exparel. Is exparel better for pain control and in terms of side effects than pain pump. If your patient would request exparel would you go ahead and fulfill pt's wish?

George Marosan, MD · Answer

Thank you for your question. I switched to Exparel when it was released and FDA approved. In my practice, this was a great advancement over a pain pump. It saved me 20 minutes in operating time (filling of the pump, placement and tunneling  of the tubes that carry the anesthetic under the muscle fascia), by easily injecting the Exparel under the fascia. I dilute the Exparel with 40-60cc of saline for wide distribution. The pain pump has a 2mm tube with multiple holes in it like a garden hose and the local anesthetic  drips out locally without wide diffusion. The added advantage is no extra tubes that the patient has to worry about. The pain control is not complete, but allows for less narcotic medication use. Pain management is multimodal. I start my patients on Gabapentin 3 days prior to surgery and continue it for a month (I use extensive liposuction of the whole torso with my tummy tucks). BTW, Exparel is somewhat more expensive than a pain pump. There's nothing wrong with your surgeon using a pain pump if she/he is comfortable with it. Good luck with your surgery.

Kenneth Hughes, MD · Answer

It is not unreasonable to request something like this, but your surgeon may have a reason for not using this in your particular case.

Nathan Eberle, MD, DDS, FACS · Answer

however one is an injection on table and the other requires catheters, Realize, your surgeon may NOT use exparel, may not have experience with it, and IF they do not use it, he/she likely won't start with you as it is $$(more than pain pump) AND has to be ordered in large quantities, which drives up the cost even more as it sits on the shelf between pts it would actually be used on. Unlike a previous reply, it has been used on TT's and Breast cases, I know bc I wrote the papers. Some older surgeons are simply uninformed/uneducated on materials that have been out on the market for several years now. Bottom line, either work, if you like your surgeon, accept his method of tx.

John LoMonaco, MD, FACS · Answer

I have used both, and both work. I have a few concerns about Exparel though.  It contains a medication (marcaine) with known serious side effects on the heart, and it has only been studied for hemorrhoid and bunion surgery - very small areas of the body. So my concern is how to withdraw that medication in a case  you had a side effect.  The pain pump can simply be turned off, the Exparel cannot.  Also with the pain pump, you can cover  larger area which is useful for tummy tuck surgery.

Sophie Ricketts, MBBS (Hons), FRACS (Plast) · Answer

I routinely use a pain pump for the first 20 hrs or so immediately after tummy tuck and body lift surgery. It works by delivering a slow continuous dose of local anaesthetic into the abdominal wall as soon as you wake up after surgery. I've found it to be a really effective pain relief method with really no side effects. Because of the effectiveness of the pain relief, it means that less narcotic analgesia needs to be used (so less side effects like nausea, vomiting and constipation) and my patients feel more able to move and get out of bed (which helps prevent venous thrombosis).

This is also the rationale for exparel use.

So, I think either would be a good option, and really it comes down to possibly cost! I don't think you could go too far wrong with either option!

This is also the rationale for exparel use.

So, I think either would be a good option, and really it comes down to possibly cost! I don't think you could go too far wrong with either option!

Moneer Jaibaji, MD · Answer

I prefer expired over pain pump and that is what I offer my patients. In my experience Exparel woks better and there is no hassle of extra tubes and drainage.

David Dellinger, DO, FACOS · Answer

Both Exparel and  pain pumps are effective methods of decreasing pain after abdominoplasty and I have used both of them on various occasions. It is important to note that neither will make you 100% pain free after surgery and in most situations decrease post operative pain after surgery by around 50%, sometimes more or less. Because pain pumps are delivering a slow continuous dose, they are more reliable in terms of pain control. Exparel can be affeected by diffusion through the tissue and your own metabolism, however there is no pump to have to deal with. Both are effective for up to 72 hours. You will not go wrong with either treatment and if your surgeon is more comfortable with a pain pump, I would consider heeding his/her advice. Good Luck

Jon A. Perlman, MD (retired) · Answer

In my practice I have recommended the application of a pain pump with its tiny catheters since it reduces pain by approximately 50 to 70%. I never had a catheter pulled out and the catheters themselves are threadlike and easy to keep in place. The added benefit of a pain pump is the supplement button that can be squeezed once every hour if needed to give a boost of more numbing medicine. Having said that, I hear good things about the use of Exparel but am concerned over the risk of release of a large dose of Marcaine which can cause fatal and irreversible cardiac arrest. This has not been reported so I do not want to exaggerate the risk but it does deter me from making the change.

My suggestion is that you allow your surgeon to follow his/her normal routine and avoid being his first experience with a new product.

Jon A Perlman M.D., FACSDiplomate, American Board of Plastic SurgeryMember, American Society for Aesthetic Plastic Surgery (ASAPS)ABC-TV Extreme Makeover SurgeonBeverly Hills, California

My suggestion is that you allow your surgeon to follow his/her normal routine and avoid being his first experience with a new product.

Jon A Perlman M.D., FACSDiplomate, American Board of Plastic SurgeryMember, American Society for Aesthetic Plastic Surgery (ASAPS)ABC-TV Extreme Makeover SurgeonBeverly Hills, California

Lori H. Saltz, MD (retired) · Answer

Both will work. The newest discovery in pain managemment I used to use the pumps until Exparel came along. I found that patients are alreaddy anxious about having the drains and adding more tubes that have to be removed freaked them out just a bit more so the Exparel has been a blessing in that regard. I also didn't like the fact that the pump tubing added another source of potential infection for several days. The tubes are not sutured in and have to be taped down. Even sewn in drains occasionally get pulled out (one patient dropped the bulb and stepped on it mid-stride). There have been no reports of Marcaine toxicity. I dilute the medication and it covers the entire abdomen nicely.The bigger change in my post-operative regimen has been the addition of pre-medicating with different pain relievers. Multi-modal pain relief is better than a single pain reliever. By suppressing different pain pathways a couple of hours before surgery, less narcotics are needed both during surgery and afterwards in almost every case. Even the anesthesiologist sees the difference when it is used. On a big case like a TT I give Gabapenten 1200 mg and 2 Celebrex 2 hours proir to the start of surgery with a small sip of water. These are one time doses. The Gabapenten is an off label use. It is also very relaxing which the patients find comforting. It can give you strange dreams the first night; not frightening, just odd.The combination of all three of these medications to my pain control regimen has been wonderful for my patients. I used it with my own facial surgery (face, neck, upper and lower lids and a brow lift) and did not take a single pain pill after surgery! Do not expect to be that pain free, but just cutting down on the narcotics you will have to take will decrease their side effects (nausea/constipation) which are fairly prevalent.

My tummy tuck is in two weeks. Exparel vs pain pump?

Answers (9)

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