Is it possible to get a tummy tuck without pain medication? How do I deal with patients who are on Suboxone?

Question

I have been on Suboxone for 6 years. My doctor said it will be ok but I am truly freaking out about going under anesthesia and how to deal with pain during post op. Doctor did recommend exparel but that last only three days.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding undergoing a tummy tuck while undergoing Suboxone. First, you can undergo surgery, anesthesia, and a surgical procedure like a tummy tuck while on Suboxone. Suboxone aids patients who have a history of opioid dependents. I suggest you let your pain medication doctor know that you will undergo an abdominoplasty. As a plastic surgeon, I would have your pain doctor dispense your pain medication after your plastic surgery. However, I would not suggest your plastic surgeon dispense the medications because you will probably require a higher-than-normal dose while on the Suboxone. Therefore, you can take oxycodone under the strict guidance of a pain specialist while still being on Suboxone. However, I suggest your addiction pain management doctor manage medications rather than your plastic surgeon. 
If you have any more questions regarding reconstructive surgery after massive weight loss, please contact my office. Reconstructive surgeries after massive weight loss include an abdominoplasty, tummy tuck, thigh lift, breast lift, mastopexy, arm lift, brachioplasty, torsoplasty, back lift, buttock augmentation, and buttock lift.  Since these reconstructive surgeries after massive weight loss,   are big procedures, please seek an experienced, board certified plastic surgeon with significant experience performing these types of lifts. Do your research.  Make sure they have performed at least 100 of each procedure you are considering for reconstructive surgery after massive weight loss.  Make sure they have the before and after pictures to prove it.  Carefully examine their before and after pictures and check their reviews on RealSelf.   D3ddddedwedwdw

Albert Ko, MD · Answer

Hi there,Thanks for your question! It is possible. Ask your surgeon to preform a nerve block, that can help significantly with post-operative pain. As for pain management, you can take Tylenol and ibuprofen alternating, and remember to cough into a pillow and wear a tight garment. You can do it!

Daniel Barrett, MD · Answer

Dear thanavady89,
I understand your concern. It is best that you consult your plastic surgeon regarding post operative care and management (i.e including massage techniques and timing) specific to your case. Your surgeon knows your condition well and has preferences on when and what to use for faster healing and recovery. Post operative care and management depends on the type of surgery performed and the technique used during surgery among other factors.It is best, however, that you follow your plastic surgeon's advice on post operative care management for a smooth and faster healing and recovery.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

You will need medication for pain, both narcotic and also nonnarcotic like Tordol or low narcotic like Trammadol.  Don't try to do this without pain medication.  Your surgeon can also use a pain pump and catheter to give a low dose of local anesthetic continually for the first couple of days.

Camille Cash, MD · Answer

Pain from a tummy tuck is the worst the first week after surgery.  The Exparel should help you get through the first few days.  Other non narcotic pain medication should be helpful after that, but may not be enough to manage your pain.  I encourage you to speak to the physician who prescribes your Suboxone as well as your surgeon about your concerns.

Manuel Diaz, MD · Answer

Hi dear, I hope you are ok, thank you for your question, it is not recommended to go through such major procedure without pain killers, for your safety and comfort after surgery is recommended to continue with what the doctor prescribes when it comes to medication.

Mats Hagstrom, MD (license on probation) · Answer

If your plastic surgeon is not familiar with managing patients pain on Suboxone then you need to find a Doctor Who is. Ideally the doctor who’s prescribing your Suboxone should be managing your pain medication but if that doctor is not comfortable, experienced or confident in doing so then you need to find a pain management physician who can take over your pain care during recovery from the surgery. 
Most experts in the field recommend weaning patients down to about 2 mg of buprenorphine per day prior to surgery and keeping the patient on Suboxone during surgery and recovery at a low-dose. high-dose narcotics even if they don’t give a euphoric affect can be highly effective at controlling pain even on low-dose Suboxone.
I would also recommend an anesthesia consultation before your date of surgery to make sure your anesthesiologist has experience with Suboxone patients. These medication‘s are now common enough that most anesthesiologist have managed and know how to manage patients on Suboxone during and immediately after surgery.
Still, it would be a good idea to make sure and ask for an anesthesia consult in advance.
Over-the-counter pain medication is insufficient and Suboxone alone will not control your pain after a full tummy tuck.
Most likely 10 to 20 mg of oxycodone on a low-dose of 2 mg of Suboxone combined with 800 mg of ibuprofen and 1000 mg of acetaminophen and possibly adding gabapentin is probably a reasonable protocol.
Unless your plastic surgeon has a solid plan of action find another provider to manage the pain postoperatively for you well in advance of your procedure.
Best,
Mats Hagstrom MD

Is it possible to get a tummy tuck without pain medication? How do I deal with patients who are on Suboxone?

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