Why are doctors not willing to use Exparal Pain Relief?

Question

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.

Mark D. Epstein, MD, FACS · Answer

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.

Steven H. Williams, MD · Answer

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.

Lewis Albert Andres, MD · Answer

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!

Richard Baxter, MD · Answer

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.

Miguel Delgado, MD · Answer

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!

Stephen Bresnick, MD · Answer

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!

Vishnu Rumalla, MD · Answer

Thanks for a your inquiry.  Pain management is an important part of every tummy tuck in my practice.  I use On-Q pain pumps on 95% plus of the tummy tucks I perform. I have used Exparal as part of tummy tucks before.  It is best placed as part of a deep muscle block that many anesthesiologists no how to do, but does need some some special equipment including ultrasound.  The greatest resistance to this drug's use is that it is expensive and not stocked by many facilities.  I am surprised that no one in your area would be able to offer you a pain pump-please ask again.

Gregory T. Lynam, MD · Answer

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!

Janet Woodyard, MD · Answer

Many doctors, like myself, use Exparel routinely.  The cost for patients at our facility is $295.  You may want to find a physician that offers the options that you want and always us a board-certified plastic surgeon. You should be comfortable with your choices before proceeding for an elective procedure.

John Paletta, MD · Answer

I agree pain relief is very important and we personally use the newer methods. The cost of the medication is really not that much different from the cost of a pain pump with localAnesthesia. If I remember correctly the cost of exparel is $3-$400.

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