When it comes to plastic surgery, I have found that many people — doctors included — expect post-surgical pain, so they plan for that assumption. This means preparing for days, weeks, or months of narcotics use. This mode of thinking begins long before any incisions are made, virtually guaranteeing a patient will be taking opioids.
Instead, I advocate for pain prevention. This approach requires strategizing ahead of any procedure, making use of modern technology, medicine, and techniques to start with not just results, but recovery in mind.
Introducing anti-inflammatory medications into the system before making any incisions can reduce post-surgical aches and throbbing sensations. Similarly, medications to minimize nerve sensitivity can also be employed, as well as anti-nausea pills. All of these are available in non-narcotic forms.
When it comes to the surgery itself, long-lasting local anesthetics are options to dull sensation anywhere incisions will be made. The gradual release of their non-opioid active ingredients allow for two or three days of post-surgical recovery with minimized pain. By the time the effects of these local anesthetics wear off, many patients have recovered to the point that residual pain is easily managed without narcotics.
I have found that muscle relaxants may also be desired as necessary to curb spasms that may trigger pain. The need for these can be determined on a case-by-case basis.
With these medications carefully planned and administered, it is possible for plastic surgery patients to treat their post-procedural discomfort with no more than Tylenol. If something stronger is needed, a non-narcotic pain reliever can be prescribed. In such cases, the medication is never needed for more than a few days.
Patients may still expect to feel groggy in the hours immediately after a surgery, as well as to have the typical bruising, swelling, and tenderness in the surgical site. Any incisions will need to heal, as usual, and typical work schedules or daily life activities should be reduced or avoided for days or weeks, depending on the surgery specifics. This is common to any surgical procedure and gives the body a chance to recover and recuperate.
The surgical techniques I’m advocating for here account for time spent healing; they do not eliminate it. Of course, every person’s personal healing ability is unique, so there will be variations in the exact amount of downtime necessary.
Plastic surgeons are especially known for planning ahead, visualizing how results of individual procedures will look just after the surgery, once residual swelling and bruising resolve, and even years later as a patient continues to age. This sort of forward-thinking ability can be harnessed to great advantage when applied equally to a recovery mindset.
Throughout my years of practice, I have found that a “narcotics-free” approach to surgery and recovery is applicable to virtually any plastic surgery procedure, including breast augmentations, reductions, lifts, and reconstructions. It can also work for abdominoplasties, liposuction, Brazilian butt lifts, arm and thigh lifts, and more.
Advantages for patients go beyond minimized pain. Avoiding narcotics during the recovery period also means avoiding side effects related to narcotics during the recovery period. That means it is possible to reduce the risk of post-procedural nausea and constipation, as well as the possibility of confusion or the need for further sedation. Considering the fact that the body is being taxed and stressed less during such a recovery, the healing itself can proceed more quickly. This allows patients to get back to their lives sooner than they would otherwise.
In my experience, I have found that recovery after these simple strategies are employed often meet or even surpass the analgesic effect of standard protocols built around the belief that narcotics will always be necessary.
Of course, patient safety and results should always come first. As plastic surgeons, we are in a unique position to improve our patients’ lives in more ways than one.
Lawrence Iteld is a plastic surgeon and can be reached at Iteld Plastic Surgery.
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