I was one of the first surgeons on Long Island to use a pain pump for a TT over ten years ago and I swore by them. 1 1/2 years ago i tried Exparel for the first time and there is no comparison. I got rid of all the leftover pain pumps. The drug costs about $300 per patient but when you consider all the benefits of little to no narcotic use after surgery, it is well justified.
It is true that hospitals and ambulatory facilities are very hesitant to buy it. Recent studies have shown that it actually results in shortened hospital stays.
I have my own Joint Commission accredited office based surgical facility so i can buy whatever I choose. I will not even consider doing a TT without it. It is not an option. The cost of the drug is simply built into our facility fee.
Thanks for your question -
You should ask your plastic surgeon why they choose not to use Exparel. It is a relatively new drug and sometimes that makes some doctors uncomfortable.
But its the patient comfort they should consider here. Exparel works wonderfully to manage post-op pain for several days. We have started offering it to all of our patients who get procedures like Tummy Tucks.
Unlike narcotics it doesn't have potential for addiction, constipation or nausea.
Our patients love it.
Hello! Thank you for your question! Exparel is an excellent form of
delivery of a local anesthetic, Marcaine. It is delivered within a
liposomes form, which is slowly released over a 72 hour period. The
injectable form lasts approximately 6 hours. It has significantly
reduced postoperative pain as well as the need for postoperative
narcotics following surgical procedures. Sometimes a small additional
fee is required for it's use, but it's benefits have been great. The
pain pumps are excellent as well as they continuously drip the
anesthetic within the pocket.
Typically, Exparel is either
injected into the surrounding soft tissue/underlying muscle layer or
just simply released into the pocket itself. If injected between the
ribs, there certainly is a theoretical, and higher, risk of puncturing
of the lung. the former methods are more common. Discuss its access as well as potential use for you with your surgeon. Hope that this helps!
I have used Exparel routinely with tummy tucks since it first became available and it has made a big difference. Since you are paying out of pocket for a tummy tuck there is no reason that I can see why it could not be made available.
I have used Exparel for patients undergoing TT and found it very useful. However it was provided free of charge by the rep from the company for me to try it out, and since I don't have my own facility, I must use a hospital or surgery center, and they are reluctant to stock the product because of increased cost. I was recently told that at one facility it is only approved for use by orthopedic surgeons for arthroscopic surgeries. It seems that as time goes on, everybody is more concerned about the bottom line than what is best for the patient. As an alternative I will use marcaine with epinephrine, which will last 8-10 hours. Of course you can always go to a pain pump, but when I have used it I haven't been impressed that it does any more than good local injections.
It is an expensive product. It is not available per the pharmacy board in most hospitals. The pain catheters work very well and are available readily. $15,000 seems a really high cost for a tummy tuck, at least to me here in Virginia where it is about $7000 with a pain pump. Please seek out a board certified plastic surgeon. Good Luck!
I have been using Exparel for all of my excisional body contouring, including tummy tucks, and breast surgery since it was introduced. We have found the pain reduction significant. It allows a remarkable difference in the early mobilization for patients. The reduced amount of narcotic based pain medication that patients require has also improved the patient experience especially by decreasing the associated side effects from narcotic use. Most of our patients are able to return to their routine daily lives much faster due to the improved pain profile. Unfortunately, Exparel is quite costly. Many patient oriented innovations never become routine parts of practice due to an expense that in many estimations does not outweigh the benefit. A patient may always ask for a value added service that may not be routinely offered. That request is likely to incur some further cost that may be worth it.
Your question is valid. The answer can vary. I use Exparel or a 4 day pain pump on all cases where I tighten the muscle fascia, or work under the pectoralis for Augmentation. To get Exparel, the doctor would have to buy 10 vials. The facility will likely not have it because of its cost. The facility may not let the doctor bring in outside meds. All facilities should approve of pumps, since they can open them sterile and fill them on site. Since patients cost shop, using it adds to the price and may eliminate the best surgeon (ie the one who cares about your pain) because he is marginally more expensive. You can demand that the surgeon use one or the other, or find someone who will use it. The difference in pain is worth the cost! Best of luck!
There are advantages and disadvantages of Exparel as well as a pain pump. Either will generally decrease the discomfort from a tummy tuck, if the muscle is tightened during the procedure. There are many plastic surgeons across the country who use these modalities and find them beneficial for improving the patient's experience with the tummy tucks?procedure. Some will charge an additional fee for their usage and others will not.
What is of greater importance is the choice of your plastic surgeon who should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.
Robert Singer, MD FACS
La Jolla, California
I switched from pain pumps to Exparel for tummy tucks as have many other surgeons. Maybe if there is enough demand the surgeons in your area will start using it. Look for a Board Certified Plastic Surgeon that has his/her own surgery center as some hospitals might not supply it. Keep looking you may find one. Good luck!