Pain pump and Exparel?

Question

I am allergic to acetaminophen therefore can't take the normal pain meds after surgery. What do other doctors do for pain management with a patient in this predicament? I have read and listened to the success of the Exparel injections. Are these injections replacing the pain pump method of pain relief? Are they used together? And if so, does the pain pump begin dispensing after the patient feel the Exparel wear off?

Scott Reis, MD · Answer

This is a fantastic question, although the answer will depend on which surgery you're planning to undergo which I don't see included in your question above. In general you are correct, Exparel has replaced the use of pain pumps in many circumstances (universally in my practice) and is great because you don't have a pump coming out of you after surgery. Also, Exparel can be injected into many different locations instead of dripping into just one area like the pain pump does. Exparel is an amazing drug, that has completely transformed post-operative pain and recovery in my patients undergoing breast and abdominal surgery. In breast cases I uses it to numb all the nerves in between the ribs so both chests are covered and in abdominal cases inject in many locations, essentially numbing the whole abdomen. For cosmetic cases, most surgeons will charge extra since it is very expensive, but the patients say they'd easily pay double after experiencing the effect vs what is typical with their respective surgery. I've never personally used or heard of anyone using exparel and a pain pump - to me that seems unnecessarily redundant, wasteful and a hassle for the patient.Regarding your specific situation, don't worry about your acetaminophen (tylenol) allergy. It's the least powerful pain medicine there is. Most narcotics come as a combo with it, however the narcotic medicine alone can be prescribed to avoid the acetaminophen. In addition to narcotic pain meds, I always write my breast and abdominal patients for valium which is a muscle relaxant and really helps with the muscle spasm and discomfort after surgery - many patients in fact say this is more helpful than the narcotic. The combination of these 2 drugs should be more than enough (especially if Exparel is used). You could also potentially take ibuprofen (motrin/advil) a few days after surgery, but you would need to clear this with your surgeon beforehand since it can cause bleeding in certain cases.Overall, I can't recommend Exparel enough, if it were me or a family member I wouldn't consider major breast or abdominal surgery without it. And for your post-op pain control, you'll be more than fine even though you can't take acetaminophen due to your allergy. Best of luck!

Andrew T. Lyos, MD, FACS · Answer

Hello and thank you for your question.I use Exparel for many of the procedures I offer.  Most of my patients elect to use Exparel for tummy tucks, body lifts, and breast reduction. The medication is injected at the time of surgery and lasts for 3 days.  It has been particularly helpful for our tummy tuck patients in that it allows them to get up and around more quickly.  Most surgical facilities will charge $350-400 for the 20 ml vial.  There is now a 10 ml vial available which should be half the cost and is perfect for case such as breast augmentation. Possible side effects with patients who received  Exparel and with other pain relievers can experience nausea, vomiting, and/or constipation. If it is not available, I have used the pain pump with good results.Best Wishes, Andrew Lyos MD FACS

Stefan Mark Szczerba, MD · Answer

Just Exparel is what we recommend!  Pain pumps and adding other local anesthetic medications is contraindicated.  Skip the pump.  You should be fine on the pain medications that can be prescribed that don't have Acetaminophen.  Best Wishes!!

William T. Stoeckel, MD · Answer

There are certainly many pain medications that do not contain acetaminophen that you can probably use after surgery. Pain pumps and Exparel can be useful, but typically are not necessary. My experience with Exparel is that it does work, but not quite as well as the company that sells it would like for you to believe. The same is true with the pain pumps. Depending upon the surgery you are considering, you could probably do just fine with an isolated narcotic (oxycodone, hydrocodone) along with a NSAID (ibuprofen, advil, alleve, etc.).

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  I have used exparel for many of my patients with significant improvement in pain control.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Thomas Fiala, MD, FACS, FRCSC · Answer

We've used the Exparel for tummy tucks and abdominal liposuction very successfully.  It lasts about 3 days, and in our experience, is superior to the pain-buster pumps.However, there are alternative medications that you can use, that do not contain any acetominophen.  For example, consider Nucynta.  As potent as Percocet, but much less nausea and vomiting.

John LoMonaco, MD, FACS · Answer

Are you getting a tummy tuck ?Pain control after surgery can be managed at several levels and time points.  I begin by injecting numbing medication into the area during surgery, and begin the pain pump before my patient wakes up.  I prefer to keep my patients overnight, and use a PCA pump to where you deliver your own medication (within safe limits) on demand.  Once I am sure you do not have nausea from the anesthesia, we can begin the oral pain medications.  There are several medications that do not contain acetaminophen that can help with pain control.  While Exparel works well, we are limited to the amount and number of areas we can use it, and using it in the abdomen is currently an off-label use.  In my area, it is also quite a bit more pricey than the pain pump.

Camille Cash, MD · Answer

Exparel works very well to help control pain the first days after surgery.  It can be combined with oral pain medication for pain management.  There are several medications available that do not contain acetaminophen.  Your surgeon will pick one that he/she feels will work best for you. If you have not yet selected a surgeon, we welcome you to visit our office for a consultation!

Jeffrey Thaxton, MD FACS · Answer

There are several alternatives to acetaminophen containing pain meds.  I have not been sold on pain pumps after surgery, others may have had good results but I have not and have not found them worth the trouble or problems.  Exparel seems to be a good choice for a few days and may be enough to get you to the point where only a NSAID such as motrin is adequate for relief.  I

Scott D. Green, MD · Answer

My experience with Exparel in my patients has been positive. We have not used a pain pump in several years and most patients tolerate the procedure very well. Most patients are able to take narcotics for 2-6 days only and then discontinue it completely. There are alternatives to acetaminophen, therefore you just need to discuss this with your surgeon prior to your surgery to make sure this is addressed. 
Best of Luck

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