Improving the cosmetic surgery experience: Pain pumps to control pain and nausea

An illustration showing common areas where the pain pump offers pain relief (from the OnQ web site)
Common areas where the pain pump offers pain relief (from the OnQ web site)

In all other branches of medicine, a treating doctor assumes that the patient has some kind of medical problem that the doctor has to fix or make better. If the patient experiences some pain, gets a big scar, or has some side effects, it’s an acceptable trade off because it’s for the patient’s benefit to attain good health.

Cosmetic surgery is different because the patient’s body is working right, and the doctor is just trying to make it look better. Our logo at is “the Science of Beauty” not only because we apply state of the art techniques to make you look better, but also we search far and wide for techniques to make our surgery safer and with fewer side effects.

When asked before surgery, most patients report fear of pain or scars. However, when surveyed after surgery, most patients cite nausea as their worst experience after surgery. Even the pain pills can cause nausea and some patients find themselves in an unpleasant cycle of nausea and pain. The nausea in itself can be very problematic, as patients need to take fluids after surgery. If they are vomiting, they can get quickly dehydrated. By far the most common causes of admission to the hospital after cosmetic surgery are nausea and vomiting.

Whether it is for Breast augmentation, Tummy tuck , Facelift, or Liposuction, our preparation starts before surgery. We supply the patient with a patch of a drug called “Scopolamine”. It is well known to people who have seasickness. You put the patch behind your ear the night before surgery. Its side effects can be sleepiness and dry mouth, but since most patients at have 7:30 AM starts, that are rarely noticed. The patch can stay on for up to 3 days. This has worked so well for us we rarely ever prescribe anti-nausea medications after surgery. We like to leave it on because patients may need to take pain medications, and most pain medications can cause nausea.

Some surgeries such as Facelift and Rhinoplasty do not have much of a pain component after surgery. Others, such as Tummy tuck, Body lift, and Breast augmentation (when done below the muscle) do have a significant pain component.

As a plastic surgeon I have a goal of minimal pain surgery, and a strategy to achieve this goal. The perception of pain starts at the moment of injury, whether the patient is awake or under anesthesia. For this reason I inject short and long acting local anesthetic agents after the patient is sedated and before surgery starts. We don’t rush to start, but wait a good 15-30 minutes for the anesthetic to be well set in before we start. Once surgery is over, the effect of the long acting anesthetics will last for 12 to 18 hours. Again, this period is crucial in the perception of pain. If you can blunt pain perception in the first 24 hours, the patient does much better. With less pain medications there will also be less nausea.

Surgeries such as Breast augmentation, Tummy Tuck, and Body lift have postoperative pain which can be intensive.

a pain pump reduces pain and nausea, as well as speeds up your recovery

My patients who are having these procedures are given the choice to using a pain pump. This is a device that has two components. The first is a small catheter, smaller than a drainage tube. It lies in the operated area and is brought out thru a pinhole sized opening in the skin. The catheter connects to a reservoir of local anesthetic, which is pumped continuously into the operated area. There are multiple benefits to this. The patient takes fewer pain medications, because she feels a lot less pain. There is less nausea. The patient gets around better, and breathes better.

After I started using the pain pump with my Tummy tuck procedures, the first thing I noticed was that fresh postoperative patients (1-2 days post op) were walking into the office! Without the pain pump, many patients were in so much pain that they would call from the car and ask for a wheelchair to be brought to the car. The pain pump reduces the pain so much that they no longer want the wheel chair! My second observation their skin looked better. With the pain pump, patients are just breathing better and moving around, so they just don’t look as sick! Needless to say, the recovery of these patients is improved because they get up and around much sooner. With the pain pump, the surgical experience is much improved, because both pain and nausea are both reduced.

I hope you learned something about some of the issues we deal with as we try to improve your care. We truly are devoted to the concept of “the Science of Beauty”, and this includes all aspects of your care, both before and after surgery.

By Dr. Ricardo L. Rodriguez MD Board Certified Plastic Surgeon Cosmeticsurg Baltimore, Maryland Ricardo L. Rodriguez on American Society of Plastic Surgeons.