Most of our patients in New Jersey want to know how painful their plastic surgery procedures are going to be and how long will they have to remain in bed. Many remark that they had negative surgical experiences in the past because of pain and postoperative nausea or vomiting (known as “PONV”). It’s true that pain management after surgery can be a challenge for surgeons because they want their patients to be comfortable but not sedated and bedridden. We have a strategy for handling these issues that keeps our patients not only healthy, but also very comfortable.
Early ambulation is a high priority at Contemporary Plastic SurgiCenter. We use a multimodal approach to pain management beginning 3 days prior to the surgical procedure. This is a great alternative to the use of opioid-based or narcotic therapy.
Opioids come with unpleasant side effects such as nausea, vomiting, and constipation. Our multimodal approach is customized to each patient and combines oral and IV analgesics and local anesthetics such as EXPAREL® to target the sources and pathways of pain with a decreased reliance on narcotics.
With the use of EXPAREL injections, which we use in particular for our tummy tuck and breast augmentation patients in New Jersey, a time-released Marcaine (a numbing medication similar to what you receive when you go to the dentist) provides our patients sustained relief for 48 to 72 hours after surgery.
These approaches do not mean that there is no necessity for narcotic pain relievers, but many patients will have a decreased need for narcotics, therefore decreasing the unpleasant nausea, vomiting, fatigue, and constipation that can result. This approach can speed recovery and eliminate many unpleasant side effects.
Additionally, we begin our PONV protocol before patients leave their homes to come to the surgicenter with the use of a Scopolamine patch. Before the incision, patients are given Decadron. Then, during the procedure, Reglan and Zofran are given. With the help of these methods, our PONV rate is less than 3%.
We know that patients’ expectations can also influence their outcomes, so our preoperative education is an important part of the surgical process. Patients are given a realistic view of what discomfort they may experience after surgery and how to manage their pain using a pain scale and the multimodal adjuncts. Many people believe that because their surgery is an elective cosmetic procedure there will be little to no post-op pain.
Pain is easier to prevent than it is to treat. Pain prevention medications, such as Celebrex, bromelain, and arnica, given before surgery provide the patient an effective head-start for controlling pain and decreasing inflammation in the post-op period. Other analgesics such as IV Tylenol and IV Toradol given before the incision also continue their effects well into the post-op period. They reduce peripheral and central sensitization and continue well into the post-op period to reduce the inflammatory response, which lasts a minimum of 3 days after surgery. That is why the first 3 days after any surgery are the most uncomfortable days. Reduce inflammation, and you can reduce discomfort.
Our patients are relieved that when they emerge from anesthesia, they are pain-free in the post-anesthesia recovery room. We rarely have the need to give pain medication other than oral Tylenol in our recovery room.