What are your thoughts on getting Exparel?

Question

I'm getting a Mommy Makeover including Breast Lift, Breast Aug, Tummy Tuck and Lipo of flanks and inner & outer thighs. My PS said he will get Exparel for me, but doesn't usually use it because he feels that the body tells you when there is a problem through pain. He said that he doesn't want to mask the pain and find out there is an issue later due to this. I am curious on your expert opinions of the need/recommendation for this. Do you recommend the use of it and why or why not? Thanks for your insight.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

This is a very good question. While I agree with your surgeon that pain is a good indicator a potential problem pain must still be controlled. Atypical pain plus other symptoms that are not customary to the procedure clue a surgeon in to a potential problem thus the decision not to use Exparel based on masking pain is not why I do not use it. My reasoning for not using Experal is based on added expense, possible interactions with other medications in surgery, possible aftercare mishaps and in my opinion it is not clearly superior to what I do in surgery to minimize pain after surgeryYou and your surgeon should develop a plan that you are both comfortable with.

Sheila S. Nazarian, MD · Answer

As you can see, every surgeon is going to have his or her opinion. I think that pain management is important and if this is something that worries you  then using exparel might make sense for you. It's really going to come down to a personal decision between you and your surgeon. My best,Dr. Sheila Nazarian@drsheilanazarian on Instagram

Kenneth Hughes, MD · Answer

I do not use it for similar reasons stated by the surgeon.Kenneth Hughes, MDBeverly Hills, CA.......

Richard Baxter, MD · Answer

In my experience, using Exparel with mommy makeover surgery reduces pain levels and the need for narcotic pain medication by about half. That means fewer side-effects from pain pills such as nausea and constipation. I say yes to Exparel for mommy makeovers.

Jeffrey D. Wagner, MD · Answer

I routinely use Exparel in this procedure and it has revolutionized the early mobilization of my patients in the first 36-48 hours after surgery.  They definitely use less narcotics, have fewer problems with nausea and vomiting, constipation and urinary retention, are out of bed sooner with much less discomfort, and have fewer pulmonary toilet issues.  It is not difficult to imagine they might experience fewer DVT's as well (although this is not proven).  It does not mask pain to the extent that major problems are not identifiable. I highly recommend it.

Nelson Castillo, MD · Answer

Thank you for your question.  Your surgeon's concerns are certainly valid, as Exparel does have long-lasting anesthetic effects as its chief advantage, but the possible negative consequences must be considered.  In many cases the additional costs of Exparel rule out its use for many patients, but if you are interested, continue to voice your desires to your surgeon so the pros and cons can be discussed.

Robert M. Tornambe, MD · Answer

Exparel is simply a longer acting local anesthetic, with the advantage of blocking pain at the site of the surgery, supposedly decreasing the need for narcotic pain medications. Your surgeon's reasoning has merit, and I usually use it on a case by case scenario. If a patient complains of a very low pain threshold, I will use it, but insist that the patient return for more frequent postoperative checkups. Discuss the pros and cons with your surgeon and best of luck.

Camille Cash, MD · Answer

Many of my patients have elected to receive Exparel during surgery.  This medication helps manage pain during the first few days after surgery.  If you choose not to use it, narcotic pain medication is commonly used to manage post operative pain.

Tom J. Pousti, MD · Answer

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. 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.

Carlos Burnett, MD, FACS · Answer

Hello. Exparel is a very useful adjunct during tummy tuck and breast augmentation surgery. Yes you will have diminished pain for about 72 hours but the absence of pain will not preclude the diagnosis of many of the possible issues that ca occur after cosmetic surgery. I personally recommend the use of this agent but you should fill the recommendations of your BCPS.

What are your thoughts on getting Exparel?

Answers (12)

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