Abdominoplasty & lipo w/o general anesthesia and Exparel use at end of procedure?

Thank you for the question. The anesthesia should be a consideration for the anesthesologist, plastic surgeon and mainly the patient. I have always had the approach of general anesthesia and Exparel for postoperative pain relief. It's the safest and most comfortable approach.

Unless there is some extenuating medical reason not to have anesthesia (that is between you and your plastic surgeon and anesthesiologist) I would not recommend an epidural for an elective , cosmetic operation.I always use general anesthesia for patient comfort and total muscle relaxation during a tummy tuck.  

Exparel has been a wonderful addition to my Mommy Makeovers.  There is specific dosage guidance in the package insert that comes with the exparel.  This will determine exactly how much marcaine (bupivacaine) can be administered during surgery.  Your anesthesiologist and surgeon should work this out for you.  Best of luck!

Thanks for sharing your concerns with us. I usually recommend oral medicines because they have a longer time of effect. The anesthesiology is who can give you better opinion about toxicity doses. Respectfully, Dr. Emmanuel Mallol Cotes.-

Excellent question.  I perform lipo-abdominoplasty under IV sedation and local anesthesia all the time in my office ambulatory OR.  And then I routinely inject Exparel at the end of the procedure -- it is perfectly safe.  The beauty part of this method is that the patient can then walk out of the office two hours after surgery with minimal to any pain -- and the Exparel lasts about 72 hours, long enough to get you over the hump of the most difficult pain period.Elliot W. Jacobs, MD, FACSNew York City

Hi, VSG1.  Exparel is a good option to minimize post-operative pain and to reduce the use of narcotic pain medicine after tummy tuck.  It can be used safely with general anesthesia or Epidural.  Please make sure that you select experience plastic surgeon and anesthesiologist.  Good luck.

Thanks for sharing your question. Very
well thought inquiry.
Both your surgeon and anesthesiologist should decide
together the dosages of local or regional anesthetics to decrease the risk of
toxicity.
In theory, the exparel delivery will be delayed for 72 hrs.
Which means that you are less likely to have the whole dose bioavailable right
away. This should be one safety mechanism to prevent toxicity. Remember that
epidural anesthesia requires fewer doses to anesthetize wider areas of the body
by injecting at the origin of the nerves. (Another safety maneuver to decrease
toxicity).
Finally, I will assume that you will be in the hospital for
at least 1 day, because of your epidural. This should give you a 3rd
safety step, by having trained nurses around the time that toxicity might
manifest (12 to 24 hrs after injections).
Wishing you the best in your journey

This is an answer best discussed with your care takers.  In most cases this should not be an issue, however the amount of local anesthesia given should be carefully followed- lidocaine and also bupivacaine from exparel.  All the best!  Dr. Tony Perkins.

There are obviously limits to the amount of local anesthesia and IV drugs that can be given based on your size, exact surgical plan and individual reaction to the meds. Your surgeon can tell you whether it is a practical, safe idea or not in concert with anesthesia's opinion.Most anesthesiologists insist on general anesthesia as at least a bailout option if first plan not working properly during the case

This is a question to discuss with your anesthesiologist and surgeon.  They will decide what the safe dose of the combined local anesthetics will be for your body weight and procedure to prevent toxicity.  Good luck.  Donald R. Nunn MD  Atlanta Plastic Surgeon.