This is an excellent question and, in my opinion, unfortunately doesn't have a simple yes or no answer. In my practice, I have gone from offering it at the discretion of the patient, to including it in every surgery with a small increase in price, to not offering it at all and dropping the price of the surgery accordingly. At this point, I have gone back to a case by case offering for a small additional fee (it is a fairly expensive medication). In truth, the reason for the evolution in my practice is that I did not find that it consistently relieved pain in everyone. I think it's a wonderful drug and if you are particularly worried about postoperative pain control, it is likely worth the small additional fee. However, much like the healing process, everyone is different and not everyone has the same amount of pain after surgery; thus I think some patients will do fine without it. For someone with chronic pain who routinely takes narcotics, it makes a lot of sense. For someone else who has had previous surgery with minimal postoperative narcotic usage, it is probably not necessary. I hope this helps. Best of luck with your surgery!