Could I wake up in excruciating pain after my tummy tuck and muscle repair?

Question

I'm having a muscle repair as part of my tummy tuck procedure and I'm hearing stories of women waking up from surgery in excruciating pain. Is this normal and to be expected or do most patients wake up reasonably comfortable?

Larry S. Nichter, MD, MS, FACS · Answer

After tummy tuck with muscle repair, most of  patients wake up reasonably comfortable - there is a reason for this - the use of intraoperative injection of local anesthetic into the surgical area and muscles being repaired.For most of my patients, I use Celebrex and Acetominophen (does not make you drowsy and less chance of nausea) plus intraoperative use of Exparel. 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).

Vishnu Rumalla, MD · Answer

Thanks for your inquiry.  I inject local into the skin and fascia and On-Q pain pumps to help my patient decrease their pain after a tummy tuck. Please discuss these strategies with your surgeon.

Mark D. Epstein, MD, FACS · Answer

it is normal to have pain after a TT. I used pain pumps for over ten years, and they work well, but they rarely alleviate the pain completely and narcotic pain medication is frequently required.Now I do not use pain pumps. Exparel is a long acting (3-4 days) anesthetic that is placed during surgery. No pumps, no clogged tubes, no pump problems at all. My patients wake up with little to no discomfort and typically take 0-6 pain pills the entire recovery, and I almost always include extensive liposuction as well with most procedures.

Adam Tattelbaum, MD · Answer

I don't want to scare you but tummy tucks with muscle tightening hurt. The keys are how the pain is controlled and how the patient responds.In my own practice I inject the abdominal wall muscles with a long acting local anesthesia before the tummy is closed. This doesn't take away all of the discomfort but it sure helps.Some doctors use pain pumps that inject local anesthesia after surgery as well. I use them on occasion myself but generally prefer not to leave extra tubes in my patients. Some patients are more tolerant of discomfort some are not. I tell my patient the goal with pain medication is to be comfortable, but not immobile and asleep for five days.For patients that are very concerned about post operative discomfort we discuss a non muscle tightening tummy tuck. This removes the same amount of loose skin but does not flatten the abdominal wall. It is a much easier recovery and makes sense for some patients although most still choose to have the muscles tightened.Discuss your  concerns with your PS and ask how he or she manages postoperative discomfort.  Best wishes

George C. Peck, Jr, MD · Answer

Excruciating pain after a tummy tuck is highly unusual. Anesthesiologists can perform a TAP Block, nerve block, to decrease abdominal pain post operatively. They will also administer narcotics, muscle relaxers, and other medications to make patients feel more comfortable.In my practice, we perform this procedure as an outpatient procedure in an accredited Medicare approved ambulatory surgery center with a Board Certified Anesthesiologist (MD/DO)Consult with a Board Certified Plastic SurgeonBest wishes

Brian Dorner, MD · Answer

ask your surgeon to inject a lot of local anesthetic (within weight guidelines of course) during your case or use tumescent fluid. This will cut down your postop pain tremendously. Most of my patients wake up with only minor pain due to my use of local anesthetic. Exparel is a newer anesthetic that last three days and can really reduce your overall pain.

Robert T. Buchanan, MD (retired) · Answer

There are many people doing abdominoplasties and the anesthesia for them. Both of these things impact the way you awaken after surgery and the subsequent pain. When done by a board certified plastic surgeon in a certified facility with anesthesia by aboard certified anesthesiologist, you should awaken with minimal pain. What the anesthesiologist does has a significant impact on immediate pain. There are also multiple things the surgeon can do to reduce the subsequent pain, such as irrigating or blocking the area with a long lasting anesthetic or using a pain pump.

Could I wake up in excruciating pain after my tummy tuck and muscle repair?

Answers (7)

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