How to manage post op tummy tuck pain in a patient who is very sensitive to narcotics ( vomiting)?

I am 36 y.o. going in for a mommy make-over on 2/24/14. I am extremely nervous about pain control as I do not handle narcotics well. I have tried Percocet (1/2 tablet), Tramadol, Tylenol with codeine before and I have gotten real nauseous and vomited. The last thing I want to do after a fresh tummy tuck is vomit. Any tips, tricks, or suggestions would be VERY welcome!

Doctor Answers 14

How to manage post op tummy tuck pain in a patient who is very sensitive to narcotics

Thank you for the question. Good pain control after tummy tuck is very important for many reasons. Besides the important concern of patient comfort, good pain control allows for better/easier deep breathing exercises and ambulation. These measures may lead to decreased incidences of pulmonary complications and/or thromboembolic phenomenon.

These days plastic surgeons have many options when it comes to pain control after tummy tuck surgery. The use of narcotic medication, muscle relaxants, non-narcotics, pain control pumps, and long-lasting local anesthetics have made the postoperative experience much better than in the past. The specific medications used will vary from one practice to another.

In our practice, all patients undergoing, tummy tuck surgery receive a postoperative pain control pump. I have yet to have a patient complain of the "hassle" factor. In my opinion, there is no demonstrable difference between the use of local anesthesia provided through a pain pump versus long lasting injectable anesthetics. There are certainly no objective studies that demonstrate the superiority of one over the other. Best wishes.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Tummy Tuck without Narcotics

If you wish to avoid narcotic pain medications then I recommend the use of Celebrex and Acetominophen (does not make you drowsy and less chance of nausea) plus intraoperative use of Exparel. Exparel is a very long-acting local anesthetic that lasts approximately 3 or more days following injection and great for Tummy Tucks and other surgeries. Not only does it prevent pain but also most muscle spasms. It lasts the same length of time that a pain pump lasts and will therefore take the place of a pain pump. This means patients can enjoy the same effect of a pain pump, but without any catheters and no pain pump to carry around.
Exparel will be available for those concerned about minimizing discomfort after surgeries such as tummy tuck and breast augmentation.
Exparel costs the same as a pain pump and produces the same result but with less hassle and works great.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

How to manage post op tummy tuck pain in a patient who is very sensitive to narcotics ( vomiting)?

As other surgeons have mentioned there is a pain pump that has a continuous drip under the skin delivering an anesthetic to the operated area. Even more effective is a long acting anesthetic Exparel that can be injected into the muscle fascia before closing the tummy tuck that lasts a few days.  In addition your nausea can be reduced by anti nausea suppositories after surgery. Doing tummy tucks without the use of drains will also significantly reduce postoperative pain but most plastic surgeons are still using these. Not all physicians are familiar with these techniques so you will need to find a surgeon who can provide you with this approach. If your present surgeon hasn't offered you these options then this physician may not be familiar with them.

William Aiello, M.D.  Newport Beach and Los Alamitos, CA

William Aiello, MD
Orange County Plastic Surgeon
4.9 out of 5 stars 48 reviews

Pain and tummy tuck surgery

You might have a few options to help with the pain that do not involve the use of narcotics. There are several types of pain pumps that many surgeons use with tummy tuck surgery that allows for a continuous "drip" of local anesthetics onto the abdominal wall after surgery. This can greatly decrease the overall pain of the surgery and make it so that narcotics are either not needed or at least greatly reduced. There is also a relatively new medication called exparel that is a long acting local anesthetic. I have used this with several of my patients and have had pretty good feedback with how well it controls the pain. The local anesthetic lasts for about 48 hours and greatly reduces the need for additional pain medication. The only problem with exparel is the cost. It costs the surgeon about $300 to purchase it. Also, you can take anti-nausea medications such as phenergan along with the narcotics and this can make things better. 

Wm. Todd Stoeckel, MD
Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 84 reviews

Post Operative Pain Control With and Without Narcotics

I am sorry to hear you've had such difficulty in the past. Narcotics can be very difficult for some patients to handle. Talk with your surgical team about strategies to help with pain as well as with nausea perioperatively. I use an On Q pain pump in some of my patients to help reduce the need for narcotics. Discuss this with your team to see if it may be an option that would work for you. Overall, nausea can be reduced by eating a small amount of food that is bland and easy to digest before taking your pain medication. There are also medications specifically to reduce nausea. I hope this helps and best wishes on your procedure.

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 114 reviews

Pain pump may help manage pain after tummy tuck

Thank you for your question. There are many good answers already provided. However a pain pump as an alternative to oral medications. The most important factor however is avoiding excessive activity and staying bent at the waist after your tummy tuck.

How to manage post op tummy tuck pain in a patient who is very sensitive to narcotics ( vomiting)?

That is a great question and I offer this alternative to all of my body contouring patients. That alternative is Exparel. It is a local anesthetic that has a lipid (fatty) coating that gives a slow, continuous release for 72-96 hours (3-4 days).

I have used pain pumps, pain balls and others in the past and found that they are cumbersome, not as predictable and often times leak or get kinked and don't function properly. The Exparel stays where you place it and does not have any mechanical malfunctions.

I would caution that you may feel too well after surgery and need to really take it easy the first few days.

Brian J. Lee, MD
Fort Wayne Plastic Surgeon
5.0 out of 5 stars 12 reviews

Pain manegment

Thank you for the question.

This is something that you have to discuss with the anesthesiologist, he's in charge of pain control as well. There are several options to avoid these side effects.

Good luck,

Dr. Campos

Jaime Campos Leon, MD
Mexico Plastic Surgeon
4.4 out of 5 stars 252 reviews

Pain control after tummy tuck

You will hurt, regardless, after a tummy tuck when you move. here's how I help my patients:
  1. Demerol for pain - it is chemically different from other narcotics,
  2. a good muscle relaxant - like Robaxin. Most tummy tuck pain is muscle spasm.
  3. a reclining chair the first 5 days, not bed. The lever gets you up and down without your muscles working.
  4. Injection of marcaine or exparel into the muscle at the end of surgery.
  5. Scopalamine patch starting the morning of surgery for nausea from narcotics the first 48 hours.
  6. Zofran (ondansteron) pills for nausea.
  7. Steroids iv during surgery if you don't have a hormone imbalance like hypothyroidism. 
  8. Intravenous Torodol at the end of surgery. 
  9. A pain pump may help a little.
  10. Tell the anesthesiologist the morning of surgery - she may have a few extra meds to help.

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

How to manage post op tummy tuck pain in a patient who is very sensitive to narcotics ( vomiting)?

Prior to your surgery, discuss this with your Plastic Surgeon, as well as the anesthesia department at the hospital/out patient center.  After discussing your medical history, they will take all this into account regarding your anesthesia.  It is also recommended that you take your meds with food post surgery to avoid nausea.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 60 reviews

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.