Why are doctors not willing to use Exparal Pain Relief?

I am very concerned about the pain factor of a TT. I stumbled upon doctors who say that the newest thing out there is Exparal which they inject before closing up a patient. Lasts for 3 days. They state the downside is its expensive. I am paying $15,000 for my TT, who is it expensive for? No doctor in my area does a pain pump either. So basically we are relying on Perocets. Why won't a doctor be willing to use this. Don't they want their patients pain free as possible.

Doctor Answers 20

Exparel - why can't you get it?

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.


Stony Brook Plastic Surgeon
4.9 out of 5 stars 231 reviews

Exparel with tummy tuck worth the cost

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.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 47 reviews

Better early relief; Exparel and Tummy Tuck

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.

Exparel for tummy tucks

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.

Why are doctors not willing to use Exparel pain relief?

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! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 24 reviews

Exparel and pain pumps for tummy tucks?

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

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 reviews

Tummy Tuck and Exparel

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!

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 68 reviews

Exparel

I have switched to Exparel- which- if injected correctly provides very good pain relief for up to three days. I no longer use pain pumps and prefer not to have extra fluid draining internally and the extra apparatus. The price is included in my fee. You still require oral narcotics but I have been finding less need for them.

Glenn Lyle, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 10 reviews

You need to pick the right doctor.

I have been using first Pain Pumps then Exparel for my tummy tucks. My patients have almost no pain for the first three days after surgery. I don't know why your doctor doesn't. You need to pick someone who does use Exparel. The $300 cost of the drug is minor compared to the cost of a tummy tuck.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.1 out of 5 stars 11 reviews

Pain Reduction Pumps: An Important Part of Tummy Tuck Surgery

Tummy Tuck is a major surgical procedure, especially when the lining of the abdominal muscles are tightened.  The procedure can produce beautiful results, but it is important to make the procedure safe and as comfortable as possible.  The use of a pain reduction pump or (On-Q Pump) is a great way to provide pain relief to patients.  The pain pump is inserted during the tummy tuck procedure.  I place the pump catheters under the muscle tightening area so that the muscle lining is bathed in local anesthestic.  Other options include the use of long lasting local anesthetics such as Esparal.

In my practice, I have found that my patients need only one-half the amount of oral narcotic pain medication when a pain pump is used after surgery compared to patients having had tummy tuck before pain pumps were available.  If you doctor does not offer a local anesthetic option, it may be time to reconsult with board certified surgeons who do!

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.