Possibly the biggest fear patients have about surgery is pain, but new products such as Exparel are making a huge difference. Exparel, a numbing agent that lasts up to 3 days, has become increasingly popular since its FDA approval in 2011, but many patients (and surgeons) are not yet aware of it. I routinely use Exparel in tummy tuck, mommy makeover, and breast augmentation patients and it has made a big difference, especially when muscle repair is needed.
For a long time the best we could do was to prescribe narcotic (opioid) medications. While effective, they can have significant side-effects such as nausea (up to 50% of patients), drowsiness, constipation, and others. The key to minimizing these problems is to reduce the pain at its source so there is less of a need for medication. This is where Exparel (also called liposomal bupivicaine) comes in. Exparel is a local anesthetic – bupivicaine – in a material that slowly releases it. A single dose provides pain reduction for up to 3 days. For many patients, the first 3 days are about the time it takes to “turn the corner” and start feeling better anyway. Clinical studies confirm that patients have lower pain scores and less opioid usage.
A secondary benefit is that patients may be active sooner, which can hasten the recovery process too. Out tummy tuck patients are often up and walking the same day, and we have to caution some not to overdo it! (Every person’s experience will be different however.) Exparel has made a difference in reconstructive surgery as well; I recently had a patient who had a bilateral mastectomy for cancer, and I performed an immediate “direct-to-implant” reconstruction using Alloderm for an internal bra. With Exparel, she was in and out of the hospital in less than 24 hours, one and done.
Baxter R, Bramlett K, Onel E, Daniels S. Impact of local administration of liposome bupivacaine for postsurgical analgesia on wound healing: a review of data from ten prospective, controlled clinical studies. Clin Ther. 2013 Mar;35(3):312.
Morales R Jr, Mentz H 3rd, Newall G, Patronella C, Masters O 3rd. Use of Abdominal Field Block Injections With Liposomal Bupivicaine to Control Postoperative Pain After Abdominoplasty. Aesthet Surg J. 2013 Nov 8. Epub ahead of print
Chahar P, Cummings KC 3rd. Liposomal bupivacaine: a review of a new bupivacaine formulation. J Pain Res. 2012;5:257-64.