I am undergoing liposuction but I can not take opiates, will I be in a lot of pain and is there an alternative way to manage it?

Question

I am doing upper and lower abdominal Lipo as well as lower hips, the doctor said I will be put under General anasthesia and be completely out during the procedure. My concern is that the post-op pain will be unbearable. I am a recovering opioid addict and am currently on suboxone. If I quit the suboxone so that I can take opiates I will go into withdrawal. If I stay on the subs I will not be able to take opiates, I need advice on how to manage the pain. I go to my pre-op appointment in 10 days.

Robert M. Tornambe, MD · Answer

Chelsea I appreciate your dilemma, but this is a conversation you must have with your board-certified plastic surgeon. Generally speaking, postoperative pain can be readily treated with nonsteroidal anti-inflammatory‘ medication instead of opiates. Most liposuction patients describe the pain after this surgery as more soreness as after a hard workout, rather than serious postoperative pain. Your particular situation is doable but  you must plan ahead with your surgeon. Good luck!

Stanley Castor, MD · Answer

Thank you for your good question. I would recommend staying on the suboxone and taking non-opioid pain medicine. Ibuprofen 800mg and/or Toradol 10mg are good anti-inflammatory non-opioid pain medicines which I have used with liposuction patients in your situation. It's best to discuss this with your surgeon before the procedure. Good luck with your procedure!

Thomas Trevisani, MD · Answer

In our Practice liposuction includes the infiltration of fluid before the procedures are performed, while the patient is asleep, that includes a long acting local anesthetic. This should minimize the post-op pain for several hours after the procedure. If you can't take opioids then there are other post-op meds avail that you should discuss with your operating Surgeon.

Kenneth Hughes, MD · Answer

It is important that you tell you PS and anesthesiologist at your pre-op appointment that you are a recovering opioid addict taking suboxone.  Have someone with you when you are recovering from the lipo who can manage the pain medication so that you are not tempted to overdose. Check in with your support network and use all of the recovery tools that are available to you.Kenneth Hughes, MD, ABPS Board Certified Plastic SurgeonLos Angeles, CA

Tarek V. Copty, MD, FACS · Answer

Dear Chelseagirl87, On your preoperative appointment make sure that you can meet with your anesthesiologist to discuss pain management. Liposuction is generally not a painful procedure and many patients opt to take tylenol alone during their recovery. Some patients due to past addiction and others due to concerns with nausea. In these patients we provide intra-operative IV tylenol with the general anesthesia and this allows the patient to wake up comfortably without the usage of opioids. Best of luck and congratulations on your recovery. 
Best regards, 
Tarek V. Copty, MD FACS
American Board of Surgery 
American Board of Cosmetic Surgery 
Jordanian Board of Plastic & Reconstructive Surgery 
Fellow, American College of Surgeons
Fellow, American Academy of Cosmetic Surgery 
Fellow, International Society of Aesthetic Plastic Surgeons

Jeffrey K. Scott, MD · Answer

Thank you for your question. Even though tumescent liposuction is usually not high on the post operative pain scale due to the lidocaine within the tumescent fluid injected during the procedure...you are correct to have a plan for post surgical pain control. Hopefully your PS is an expert on liposuction but likely doesn’t have expertise in managing pain in recovering opioid addiction patients. In this scenario there should be a very clear game plan post operatively. I find that it is best that the pain specialist manage ALL aspects of your pain control post operatively and the PS manage all aspects of the liposuction post operatively.

John J. Bandeian, MD · Answer

I am a plastic surgeon and also treat about 20 patients with suboxone. I have done breast augmentation on two women who are being treated with suboxone by another physician. You should inform  you plastic surgeon that you are on suboxone. I instruct my patients who are on suboxone to stop taking suboxone 2 days before the surgery. Suboxone binds tightly to the opiate receptors in the brain and therefor, patients do not go into bad withdrawal until about 5 days. After your surgery, you can take oxycodone. Suboxone is a competitive partial inhibitor of narcotics. That means that if you take enough narcotics, they will displace buprenorphine from the opiate receptor sites and relieve your pain. If you plastic surgeon has any questions about suboxone, I  would be happy to speak with him.

Mats Hagstrom, MD (license on probation) · Answer

Typically the pain after liposuction is not that bad. Most patients do fine taking 800 mg of ibuprofen.  It's very important your anesthesiologist is aware that opiates will not work on you while taking Suboxone.  This is important because even while under General Anastasia the pain needs to be controlled. This is also true for when you wake up.  I do all liposuction and procedures using local anesthesia with mild sedation. This way patients are numbed completely otherwise the procedure can't be done while awake.  This assures patients are also comfortable for the  first few hours  after the procedure.  Personally I think this is a much better way to do liposuction and then to use general anesthesia but not all plastic surgeons have trained in doing liposuction as an awake procedure. Another option is to add some long lasting local anesthetic to the numbing solution placed just before the liposuction is done. Talk to your plastic surgeon and see if you can meet with one of the anesthesiologist or the anesthesiologist who will be doing your anesthesia.  Getting the stuff taken care of before surgery rather than the anesthesiologist flailing in the recovery room seems like a better idea. I would venture to say most anesthesiologist have some experience with patients on Suboxone but not all of them  Best, Mats Hagstrom MD

Jon Ver Halen, MD, FACS (license suspended) · Answer

Dear Chelsea,
Hello and thank you for your excellent question. In my practice, we do not use opiates or narcotics for liposuction. Narcotics are not used during the procedure, and ibuprofen and other non-narcotic pain medications are used for postoperative pain. You may want to look into a minimally invasive, quick recovery body contouring procedure. We use a combination of non-surgical, minimally invasive techniques including liposuction, laser, radiofrequency (RF), and acoustic therapy to produce the best balance of fat reduction, skin tightening and smoothing for your body type and anatomy. In many patients, we also use Emsculpt to help each patient reach his or her desired result. These procedures are typically performed in the office, with only local anesthesia. Patients literally “walk in”, and “walk out” after the procedure, do not need narcotics for pain control, and can return to light exercise and work one to two days after their procedure. In my practice, we select the appropriate treatment for each patient based on their skin quality, amount of fat and surgical goals. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate you. Preoperative visualization with Crisalix can simulate what your body will look like, and can help you make your decision. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. Good luck!
  
Best,
  
Jon Ver Halen, MD FACS

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