What percent of your patients were able to only take OTC medication and gabapentin without any opioids?

Question

I am a 40 year-old woman 5’2 and 130 pounds. I am overall pretty healthy, exercise and take care of myself. I do have Hashimoto’s. I have a breast reduction scheduled soon. absolutely do not want to have to take prescription pain pills unless absolutely necessary. I am wondering what percent of your patients are able to manage on just OTC medication’s and gabapentin.

Christine Fisher, MD, FACS · Answer

Hi Intellectual.  The majority of our patients take minimal to no narcotics after surgery.  We use a few different techniques to facilitate this.  First of all, we premedicate patients with non-narcotic pain medication just prior to surgery.  Secondly, we utilize a long-acting local anesthetic (Exparel) that is injected in the operating room and lasts for 3 days.  That alone has made a significant difference in the need for postop narcotics.  Lastly, we have patients take scheduled non-narcotic pain medication (tylenol, nsaids and gabapentin) for the first few days after surgery and keeping those in your system on a scheduled basis, reduces pain.  I encourage you to seek out a board certified plastic surgeon that can offer you the above to minimize narcotics while reaching your aesthetic goals.  Best of luck!

Shitel Patel, MD · Answer

You're not alone in wanting to avoid narcotics after surgery, and we completely understand.
At our practice, we actually do not prescribe opioids or narcotics post-operatively, and our patients consistently do very well with this approach. We use a multimodal pain management protocol that includes gabapentin and over-the-counter medications like acetaminophen and ibuprofen, along with long-acting local anesthetic (like Exparel) used during surgery to significantly reduce discomfort for the first few days.
The vast majority of our breast reduction patients recover comfortably without the need for prescription pain medications.

Edward Daniele, MD · Answer

I would say roughly about 40-50% can manage this way. I would say it's important to ensure that during the surgery a pectoral block is performed for anesthesia. This will allow the first few postoperative days to be more comfortable. You will feel sore after surgery, but generally is something is very painful you should see your surgeon.

Ajaya Kashyap, MD · Answer

Thank you for your query. I get a few individuals who prefer to have no opioids after major surgeries like breast reduction,  for a variety of reasons. I use long acting local anaesthesia or nerve blocks  for such individuals and they do fine. Some do fine even without long  acting local anaesthetics. The percentage of such individuals in my practice is about 10 per cent. Please discuss all your concerns with your Plastic surgeons who can help you. All the best!

Krishna Vyas, MD, PhD, MHS · Answer

In our experience, most breast reduction or top surgery patients do not require opioids for post-operative pain control. In fact, almost all of my patients are able to tolerate Tylenol and Motrin post-op due to a refined Enhanced Recovery Protocol for Breast Surgery, Breast Reductions, and Top Surgery. This pathway focuses on optimizing recovery and minimizing discomfort for our breast surgery patients. One key aspect of this approach is avoiding the use of narcotics for pain management. Instead, our protocol utilizes long-lasting local nerve blocks to ensure a pain-free recovery while prioritizing non-addictive alternatives. This minimizes the risks and side effects associated with traditional pain medications (such as constipation), allowing for a safer and more comfortable healing process. By reducing tissue trauma and using advanced nerve block techniques, our protocol promotes a quicker return to daily activities.
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Wayne I. Yamahata, MD · Answer

I find that patients are frequently surprised that the pain from a breast reduction is less than they anticipated. I cannot state a percentage, but I will say that it is not uncommon for patients to tell me that they don't want opioid narcotics and decide successfully that they will get by with Tylenol alone.

Jonathan Heistein, MD · Answer

While most people do use some narcotic pain medicine, it is definitely possible to tolerate the procedure with OTC meds afterwards.  It depends on several factors, but it can be done.  Pain is certainly subjective so some people tolerate it better than others.  Talk to your surgeon about this.  Best of luck!

Chet Mays, MD · Answer

Thank you for your inquiry! Unfortunately, everyone has different pain tolerances after surgery. It's best to know your specific pain tolerance and how you respond. Some patients take the prescribed narcotics for the first 24-48 hrs and some patients are fine with just taking OTC pain medications.

James Knoetgen, III, MD · Answer

Your concern about avoiding prescription pain medications after your breast reduction is completely valid, and many patients successfully manage post-operative pain with a combination of over-the-counter (OTC) medications and gabapentin. As a practice we do not presribe Opiods and our aptients do well with the OTC pain meds, Gabapentin and the use of a muscle relaxer or pain pump as clinically indicated. 
Many women who are in good health, like yourself, tolerate breast reduction surgery well with non-opioid pain management. Factors that contribute to this include:
•	A structured pain management plan with scheduled OTC meds (acetaminophen and ibuprofen)
•	Gabapentin’s ability to help with nerve-related pain
•	Ice packs and post-op care strategies to reduce discomfort
Patients who are especially motivated to avoid opioids often do well with a well-managed multimodal pain regimen. However, pain tolerance is highly individual. It may be helpful to discuss this with your surgeon to ensure your pain management plan aligns with your goals while keeping comfort in mind.

Connie Hiers, MD, FACS · Answer

I prescribe narcotic and nonnarcotic medication to all patients. I have had some patients take none, some take some, and a few take up to a week. What medication you need depends upon your pain tolerance. With Hashimoto's, be checked for a dairy allergy.

What percent of your patients were able to only take OTC medication and gabapentin without any opioids?

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