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?
Answer: Results with Exparel? 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!
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Answer: Results with Exparel? 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!
Helpful 5 people found this helpful
Answer: Exparel - It's Worth the $'s 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.
Helpful 1 person found this helpful
Answer: Exparel - It's Worth the $'s 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.
Helpful 1 person found this helpful
January 9, 2020
Answer: Exparel to reduce pain from tummy tucks 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.
Helpful 2 people found this helpful
January 9, 2020
Answer: Exparel to reduce pain from tummy tucks 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.
Helpful 2 people found this helpful
February 5, 2017
Answer: Have you used the drug Exparel during a tummy tuck with muscle tightening procedure and what have been your results? 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.
Helpful
February 5, 2017
Answer: Have you used the drug Exparel during a tummy tuck with muscle tightening procedure and what have been your results? 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.
Helpful
February 5, 2017
Answer: Experal for pain control post abdominoplasty 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.
Helpful
February 5, 2017
Answer: Experal for pain control post abdominoplasty 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.
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