How Does a PS Decide to Offer a Pain Pump or Not for a Tummy Tuck?

Hello, I was wondering why or why not do u give a tummy tuck patient a pain pump? Thx so much.

Doctor Answers 6

Tummy Tucks need help with pain

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A tummy tuck is a painful procedure because of the tightness that is applied to the muscles along the entire length of the abdomen.  Some patients take this better than others but it is important that a patient maintain good pulmonary function and ambulate.  I routinely use the local anesthetic pain pump because I feel there are some patients that greatly benefit however, there are times when I think it was not helpful; I can not predict.  I have modified my catheter insertion locations over time and this has helped.  Using a bolus of local anesthesia in the muscle wall does provide a lot of help to all patients during the initial recovery.  I want to try and make the recovery experience as comfortable as possible so I take what ever measures are safe and reasonable.

Best Wishes

Dr. Peterson

Saint George Plastic Surgeon

Use of pain pumps is a matter of preference for patient and surgeon

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Hi there-

Whether or not your surgeon uses a pain pump as a component of your postoperative pain management is something you should discuss with him, and which should be decided by the two of you after a careful conversation.

Any qualified plastic surgeon will be capable of placing it for you at the time of surgery, although you should be aware this will likely increase your costs a bit, as these can cost up to $450 per pump.

The bigger question, of course, is whether or not it is in your best interests to have a pain pump placed.... I have performed many tummy tucks with, and many without, pain pumps. In my experience, the pump caused more problems than it helped...

You see, even with proper insertion of a pain pump, you will STILL have pain after a tummy tuck. And when you have pain, because it is unpleasant to have pain, you will likely have anxiety about the pain and whether the pain means that the pump is not working.

If you speak to any anesthesiologist (the medical experts on pain and the way the brain handles it), they will tell you that anxiety significantly elevates the intensity with which ANY amount of pain is perceived by ANY patient. This is why (in the hospital) we sometimes give patients experiencing what seems to be unusually intense pain for the procedure performed a mild sedative/anxiolytic- it dramatically lowers the intensity of the experience for them.

In other words, many women spend so much time and energy worrying about the pump and whether or not they should be hurting as much as they are with the pump in place, that I felt putting them in was actually worsening the recovery experience for my patients.

I still put them in when patients request them, as long as they understand these limitations, because some people do want them. But please don't think they are somehow going to make you pain free (not even close). If they were always effective and were as great as you might be thinking (or as great as some surgeons who use details like this as a marketing tool would have you believe) we would all be using them, right?

Pain pump or not after tummy tuck?

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I assume the "pain pump" you are talking about is a small catheter infusing local anesthetic under the lifted and tightened abdominal skin and not an intravenous pump (PCA).

If that is the case, I can tell you that I used the local anesthetic catheter/pump system routinely for several tummy tuck patients and found no difference in the patients' need for oral analgesics.  The catheters were inserted correctly inside the rectus (muscle) sheath, and the pumps were functioning properly.  I DID notice an increase in the amount and duration of fluid collection through the drains, though.  So, I decided it was not worth it and have discontinued this practice.

I now opiate analgesics, muscle relaxants, and ice.  My patients find this combination to be very effective.

Pain Pump vs Exparel Considerations

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Your plastic surgeon will discuss with you the options available and his recommendations for the most comfortable recovery. In my patients I recommend Exparel rather than a pain pump in most cases. . 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.
Narcotics are used only as needed (as cause nausea, vomiting and constipation as frequent sided effects).

Pain pump not very effective

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There is at least one study that does not show a benefit of pain pumps in abdominoplasty. Many plastic surgeons are aware of the painful plication(muscle) sutures and use long lasting local anesthesia for this. Now there is even a longer acting anesthetic called Exparel that can provide pain relief up to 72 hrs. I would discuss this option with your plastic surgeon.

Using the Pain Pump for Tummy Tuck Surgeries

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Thank you for your question.

In my practice, I routinely use a pain pump for every tummy tuck surgery.  This is a very large procedure and usually quite uncomfortable for the first week so with the use of the pain pump, patients are able to tolerate things a little better.

I believe each surgeon's office is different so discuss this with your surgeon and see what he/she recommends.

Best Wishes.

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.