Have you used the drug Exparel during a tummy tuck with muscle tightening procedure and what have been your results?

Question

I will be having a tummy tuck with muscle tightening in March, 2017. My plastic surgeon has recommended Exparel to aid in pain relief and healing. The doctor will administer Exparel during surgery for an additional $500. He highly recommends Exparel and he says will help me feel better for the first two to three days because it numbs the area. What are your experiences with your patients (or the patients themselves) regarding the additional cost, the use of Exparel and the results?

Jeffrey A. Sweat, MD · Answer

As with most questions on Realself, the answer to your question would seem to be a simple yes or no and thus, you are going to get some docs who say "yes, I routinely use it and love it" and others who are going to say "no, it's completely unnecessary".  Perhaps a more detailed explanation could be helpful for you.  I started using Exparel around the time it was introduced on the market, and at the time, I was doing both tummy tucks and breast reconstruction using a TRAM (a modified tummy tuck in which the fat and muscle are used to reconstruct the breast).  I was initially using pain pumps for postop pain relieve in my TRAM patients, but the cost and bulkiness of the device prevented me from using it on tummy tucks (TT).  However, when Exparel was introduced, it offered a great solution to the pain pump with similar postop pain relief and no external device.  It worked very well in TRAM patients, but due to the cost (about $300/dose with a single dose per patient), I initially only offered it to TT patients who wished to pay the added $300 cost, with no markup and thus no profit to me (it didn't seem right to make a profit off a pain relieving medication but at the same time I couldn't justify charging all patients this fee if they didn't want it).  It initially seemed to work well and eventually I started adding the cost to the tummy tuck procedure and all patients were getting Exparel.  Then, in early 2015, the manufacturer decided that the hefty cost per dose at $300 was not sufficient and increased the cost to $330/dose (it can only be purchases in sets of 10, thus increasing the supply cost by around $300 from $3000 to $3300).  I initially asked the product rep to maintain the supply cost at $300/dose but my request was refused.  At that point, I decided to stop using the medication and noticed virtually no difference in postop pain relief in my patients.  Some patients report very little pain after a tummy tuck and others a great deal more, but the use of the Exparel didn't seem to make a huge difference.  I still have an agreement with a local outpatient surgery center to purchase single doses for patients that specifically request it, but it is rare that I use it anymore.  In the 200+ tummy tucks I have done since no longer using it in Feb 2015, I have noticed little change in postop pain relief and I find that NSAIDs such as IV Toradol intraoperatively or immediately postop combined with oral Ibuprofen starting the day after surgery supplementing any narcotic that I have prescribed works as well as anything.  I think Exparel is a great drug, but as with anything in life, the cost/benefit has to be sufficient to justify its use and for me it simply isn't there.  Best of luck with your tummy tuck!

Steven Teitelbaum, MD · Answer

I've used it since it came out and it has improved recoveries.We've also started using IV Tylenol during surgery and sending it with patients to the recovery facility for the first 24 hrs.While oral Tylenol doesn't do much, the IV form has been shown to be rather powerful and has reduced narcotic requirements.The worst part of a tummy tuck is actually not the pain in the first few days; it is the back aches many women get about a week after surgery from bending over.

Wayne I. Yamahata, MD · Answer

As the tummy tuck is one of the more painful procedures we perform as plastic surgeons, I am always looking for ways to improve my patients comfort. When "pain pumps" became available I routinely used these for all of my tummy tucks and found a notable improvement in my patients. When Exparel became available I found the pain relief to be comparable to the pain pump and preferred by patients because they didn't have to carry around the extra apparatus. I therefore currently use Exparel in essentially all of my routine tummy tucks.

George Marosan, MD · Answer

Thank you for your question. I started using Exparel when it was first approved by the FDA. Much better on patients than pain pumps (you have to carry around your neck), easier to inject (1 min vs placement of pain pump catheters 20min), cuts down on operative time, pain medication requirements. This in turn leads to less nausea and constipation from narcotics. I advise you take the offer. We do not charge for the Exparel in my practice, but it does cost about $400 per vial. Good luck with your surgery.

Christopher T. Maloney Jr., MD · Answer

Thank you for your question. In my practice I use Experal for every abdominoplasty I perform. Several years ago, many of us used a pain pump that dripped 2cc of marcaine into the incision delivering about 48 hours of pain control. Once the Experal came to market, I alternated every other patient with either the traditional pain pump or the Experal. After about 6 months, I went exclusively to the Experal. It is safe and effective at giving patients about 72 hours of pain reduction. It "numbs" the area same as lidocaine and marcaine, it just lasts longer. I include it in the cost of the procedure and just charge our cost. Other surgeons give patients the option. My patients and I have been very happy with the results so I include it and use it on everyone which makes my patients happier with their recovery. I suggest you use it, but it is up to you and your surgeon. Best of luck.

Richard Baxter, MD · Answer

I have been using Exparel with tummy tucks for a couple of years now and we have done studies confirming that pain scores are lower and patients require fewer pain pills. This also means fewer side-effects such as nausea and constipation. We now place it using a technique called a TAP block which seems to produce a more uniform effect.

Dallas Buchanan, MD · Answer

Thank you for your question. Exparel has been on the market since it was approved by the FDA at the end of 2011. As with most newer drugs like this, you will find some believers and some non-believers. Usually older surgeons who have been performing procedures without it and having success do not see a reason to change what works. I find that while the company reports a 72 hour effectiveness, I think it is shorter than that. And also, do not expect the medication to make things numb to the point where you do not need pain medication. In my opinion, it is effective, but only at reducing, not eliminating pain, during that period and decreasing the need for narcotic pain medication.One other factoid, a quick google search will show you that the average wholesale price of Exparel is around $285 per vial, so if your surgeon is selling it to you for $500, that is a significant markup ($215). The one way to find out if he is a real believer is to ask him if he will administer it for $350 or some other reduced amount (to account for supplies and time to inject). If he says no, he is doing it because it makes him extra money, not because he believes in the effectiveness of the product. Just a thought.....Best of luck!

Leilie Javan, MD · Answer

Hi and thank you for your question.
Exparel is one of several ways to aid pain relief following your tummy tuck. We don't require it's use. When we don't use  Exparel, we do use other local anesthetics. My tummy tuck patients range in age from 23 to 75 and do very well. Almost no one stays over night. They have the option, but only about 1 percent pursue that option. 
Best wishes on your procedure,

Robert J. Spies, MD · Answer

I have been offering and using Exparel for several years.  I do think it helps relieve some of the post-operative pain after the tummy tuck.  Some patients only need valium for muscle relaxation and can avoid the use of narcotics which usually cause constipation.  My patients are admitted to an overnight recovery care center.  The nurses who care for them all agree Exparel allows the patient to ambulate better (so important to reduce the risk of blood clots) and not require a lot of narcotics.It is an added expense but I think it is worth it.  I offer it but not demand that they have to purchase it.  There are patients who get by without it today just as there were before it was made available.  Pain relief is very important.  Exparel helps.

Kenneth Hughes, MD · Answer

I do not find the need to use this in my patients, but some surgeons do like to use this.  Kenneth Hughes, MD

Have you used the drug Exparel during a tummy tuck with muscle tightening procedure and what have been your results?

Answers (18)

More Tummy Tuck Questions

WE SEND PRETTY
EMAILS

Answers (18)

More Tummy Tuck Questions

Marijuana usage for post operative pain relief after full tummy tuck?

Is paralysis required as part of anesthesia for a tummy tuck?

Crease in upper and lower belly button area? (Photos)

Tips on straightening up after full TT?

Can I start running 7 weeks after belt Lipectomy?

How long will it take for me to stand straight after a tummy tuck? I am 2 weeks post op. I can't stand up straight.

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS