Is a pain pump really necessary?

Question

I went and did my initial consultation with my PS. He's great and took the time to answer every question. I got the estimate on my way out the door. One thing I noticed was $1000 for a pain pump. My question is, do I really need this? Would oral pain medicine be just as effective and save me $1000? What are the pros and cons?

Leila Kasrai, MD, FRCSC · Answer

The pain pump is preference of the surgeon. It is not absolutely necessary, but can certainly help some patients deal with the discomfort. You should ask your surgeon about the pain pump and if there is a sufficient alternative.  My patients discomfort is adequately controlled with anti-inflammtories and other oral pain medications.

Michael S. Beckenstein, MD · Answer

I never use them and my patients do extremely well with the pain medicine I prescribe for them. I think it is completely unnecessary !

William T. Stoeckel, MD · Answer

Pain pumps are not necessary. But they can slightly improve the post operative pain. 95% of my patients do not use pain pumps or long acting local anesthetics and do just fine. The pain after a tummy tuck is not quite as bad as most people tend to think it will be. You certainly will be sore for a week or so. And you will likely need narcotic pain medication for the first 3-5 days. But it is completely tolerable. Pain pumps should not be that expensive either. An average pain pump will cost the physician between $200-400. Increasing that cost to the patient $1000 seems a bit aggressive. Another option would be to use the relatively new long acting local anesthetic Exparel. It is also a bit costly. The cost to the surgeon is about $300. Most surgeons are not trying to make a profit on the Exparel, but certainly could be justified in charging a little bit more than the actual cost.

Frank Lista, MD · Answer

At my clinic I use the pain pump with all my tummy tuck surgeries.  It is
included in the cost of surgery.  The
result is that patients feel absolutely no pain. The device delivers a
long-acting local anesthetic automatically for the first 24 hours which means that our patients do not usually
need to take prescription pain medicines that can be associated with
significant side effects such as nausea, vomiting and allergic reactions . My patients love the pain pump.

Richard Baxter, MD · Answer

Pain pumps work by slowly infusing a numbing medication into the surgical site but a newer option called Exparel accomplishes the same thing without the need for catheters and an external reservoir. By blocking some of the pain with numbing, the need for narcotic medication is diminished. Narcotic medications are associated with significant side-effects including nausea, constipation, and mental effects. However, this should cost around $300-400, as would an On-Q pain pump. Perhaps the facility your surgeon uses determines the fees.

Laurence Weider, MD · Answer

I assume the pain pump would be used for the tummy tuck.  I usually use them for tummy tucks but not for breast augmentations or breast lifts.  While I think they help decrease the narcotic needs of the tummy tuck patients, each patient has such a different pain tolerance that it is hard to know how beneficial they are.  Some of my patients decide not to purchase the pump, and they typically do fine as well. Exparel is also a good alternative. I would agree with others who stated that $1000 seems pretty expensive for a pain pump.

Luis Macias, MD, FACS · Answer

I have used pain pumps, Exparel, and do many tummy tucks nowadays without either.  Pain pumps are not new and they may be useful, but with Exparel on the market I no longer offer them.  Exparel, usually a couple hudrend dollars,  is new and does seem to reduce the amount of narcotics used postoperatively similar to the pain pump.  However, there are 3 busy surgeons in our practice and we rarely use it as we have had great results and little complaints about the recovery using oral narcotics. Additionally, I perform No-Drain Tummy Tucks, which are a bit more painful because of extra stitches performed to make the use of drains obsolete.  I do offer Exparel to my patients, but most don't do it because of the cost and my discussion as to how most patients do well without it using oral narcotics alone. Those that do use it, do seem to need less narcotics and have less issues with constipation because of that. In the end, it's up to you. Best of luck.

Douglas L. Gervais, MD · Answer

Dear Cunninla, This is one of those " there is no right answer questions". Some surgeons use the pain pump and others do not. We have not used pain pumps in our practice (2 surgeon private practice) and most of our patients are off of their narcotic pain medications within 3-5 days of most of our procedures. We do this by preventing the pain cycle from starting. This includes keeping the patient comfortable during and after the procedure in the recovery room. We use long acting local anesthetic into the surgical area as well. Muscle relaxants are used when appropriate to prevent muscle spasm which can lead to pain. $1000 seems very high to me as well. Ask you surgeon to reconsider its use. Good luck. Dr. Gervais

Ronald Schuster, MD · Answer

$1000 sounds a bit expensive for a pain pump. You might want to consider asking your surgeon to use a relatively new medication called Exparel. It is a delayed release form of a long acting anesthetic called bupivicaine. Patients can be comfortable for up to 4-5 days after surgery. It is injected into the tissues at the time of the surgery and there is not any need for additional tubes or pumps. Good luck.

Lee E. Corbett, MD · Answer

I insist that all of my tummy tuck patients have a pain pump. They make the recovery from a tummy tuck substantially easier. I use the On-Q pain pump but the price on those is in the $250-$300 range, not $1000. You might want to check with your doctor and see if there are other pump choices.

Is a pain pump really necessary?

Answers (16)

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