Nerve blocks for abdominoplasty?

Question

I hate opioids. I get severely nauseated from them. I had great success with a 2 day nerve block (wore it home) after 2 ACL repairs. But many plastic surgery practices are telling me they don’t do these and oral opioids are standard. Why do practices not offer these blocks? One practice I spoke with suggested I stay overnight at their surgery center to help with pain control. Does this mean I would receive IV opioids until time to go home?

Dean Fardo, MD · Answer

I agree with you that opioids are best to be avoided if possible.  Fortunately, that is possible even after a tummy tuck procedure.  Find a plastic surgeon comfortable using exparel.  It is a long acting (3 day) local anesthetic that can be used for nerve blocks and pain control.  The need for opioids after using exparel can be minimal to none.  Good luck.

Adam C. Augenstein, MD · Answer

Using long acting local anesthetic injections at the time of abdominoplasty have greatly helped reduce the use of narcotics after this procedure.  Combining with other non-narcotic medicines further enhances this positive effect and patients definitely do better in their recovery.  Best of luck.

E. Ronald Finger, MD · Answer

To control postoperative pain or discomfort following on abdominoplasty, I routinely use nerve blocks, which are called costal blocks. These along with the no-drain or drainless tummy tuck technique reduces the pain tremendously. Progressive Tension Sutures must be used for this to utilize this technique.
In addition, the product Experal is injected in the abdomen where the nerves are and this product anesthetizes the area for 48 hours. After 48 hours, the discomfort will have subsided significantly. Muscle relaxants can be used if necessary.
Another advantage of the no drain tummy tuck is the more rapid recovery time, and you won't be encumbered with the drains for 5 to 10 days. PAn additional bonus is the complication rate is significantly lower.
Using the above mentioned techniques, blocks, etc. you will probably not need the narcotics that you dislike so much.
Thank you for your question, and best of luck to you.

Andrew Gear, MD · Answer

I try to minimize the use of opioids like Percocet since it slows recovery and is not as effective as one would assume.  You can use a mixture of long acting local anesthetic along with anti-inflammatory meds in a multi-modal approach to pain.  The key is pre-emptively treating pain BEFORE it appears.  Nerve blocks are overkill and I rarely do it.  Some people do it but its not the norm.

Christopher L. Hess, MD · Answer

All of my patients get a TAP (transverse abdominis plane) block prior to surgery.  The anesthesiologist will sedate the patient in the preoperative area.  Then using ultrasound they place long acting local anesthetic into the nerves that supply the mid and lower abdomen.  This give good pain relief for about 48 hours.  In addition I inject long acting local anesthetic into the rectus muscles of the upper abdomen to reduce pain in this area.  To me this should be the standard of care.  It really allows us to cut down on the use of narcotics during and after surgery.

Nerve blocks for abdominoplasty?

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