Tummy tucks hurt. Of all of the surgeries we do as plastic surgeons, abdominoplasty hurts the most. Not because of the large scar, but because we are tightening the abdominal muscles, the internal corset which fixes the diastasis (rectus muscle separation) which happens with pregnancies. The pain of an abdominoplasty is bad for the first few days, and patients stay on medication for 1- 2 weeks.
In the past, we gave pain pills alone. This usually involved a narcotic (like Percoset) and a muscle relaxant (like Valium) to help ease the pain. These work, but there are issues with giving these medications.
- Narcotics have side effects. Constipation, nausea, making you feel out of it.
- Narcotics are addictive. There are new statistics which indicate 6% of surgical patients go on to chronic use or abuse. (!)
- There is much science which shows if you never mount the first pain response- if we, the surgeons, can block it- your overall course is much less painful and smoother.
- We cannot give NSAIDS (ibuprofen, Naprosyn, motrin, toradol) because these increase the risk of bleeding.
So for years, I have used implantable pain pumps (the Q pump), which release numbing medication for the first 3 days after surgery. This helped my patients be more comfortable and take less pain medication.
A year ago, I switched to a long acting injection of numbing medication, Exparel, which time releases over 3 days. Exparel is bupivacaine (a numbing agent like lidocaine, but longer acting), wrapped in a microscopic liposomal “foam”, which allows it to slowly release. It is expensive, but I like it because
- There is no pump to deal with,
- It reduces the amount of oral medications you take,
- It reduces the issues of those medications like constipation and nausea, and
- It blocks the initial pain response.
Again, as I stated above, if you never feel the big pain response in the first place, your recovery is better- faster, less pain medication, and less pain.