The fear of pain after surgery is what causes some patients to delay elective cosmetic surgery until they can 'get up the nerve.' It does not have to be that way. There are some simple, low to no cost treatments that can be done at the time of surgery to markedly reduce pain and ease the recovery.
It was shown in the orthopedic literature four decades ago that when you dramatically reduce a patient's pain before they arise form the anesthetic, they take much less pain medication in the long run. Therefore, the simple process of injecting local anesthetic into the area of surgery just prior to closure can substantially reduce a patient's pain; sometimes such complete relief that they wind up taking no pain pills at all.
One way to do this is in the use of tumescent fluid. Standard tumescence includes a very dilute concentration of xylocaine and epinephrine. The xylocaine is a local anesthetic commonly used in dental offices and provides anesthesia to the area in which it is injected. The epinephrine constricts blood vessels to reduce bleeding during surgery and delays the absorption of the local anesthetic sot hat the effects last longer. Tumescent anesthesia was originally developed so that liposuction could be performed without general anesthesia in an office setting.
By adding bupivacaine, a much longer last local anesthetic, to the mixture, the effects can last for many hours. This is particularly helpful in bigger procedures such as tummy tucks where the pain from the muscle-tightening portion of the procedure can be significant. Using this mixture in virtually all of my abdominoplasty cases, I have had many patients take nothing but acetaminophen after their procedures and most others off of narcotics in just a few days.
Use of tumescence adds no cost and only a few minutes to the procedure but can drastically improve a patient's recovery. I find that it helps with facelifts, neck lifts, breast augmentation, breast lifts, breast reductions, tummy tucks, liposuction, arm lifts and thigh lifts. In other words, almost every procedure I do except eyelid surgery, rhinoplasty and otoplasty (cosmetic ear surgery) where there is no room to infiltrate the tumescence.
At the Upper Arlington Surgery Center (aka Riverside Outpatient Surgery Center), where I perform the majority of my procedures, it is not uncommon for new nurses in the recovery room to ask me why my patients do so much better than other patients who have the same procedures by other surgeons as they notice that my patients tend to have less pain in the immediate postoperative period. I simply explain to them my use of tumescence in the operating room during surgery and they understand.
As a result of patients taking fewer narcotics after surgery, they have fewer problems with opioid induced constipation, which can be debilitating and difficult to treat when it gets severe. To prevent this, we also recommend that patients start stool softeners and laxatives as well as significantly increase their fiber intake prior to any procedure where they may be taking pain medications.