Pain and discomfort are some of the most common concerns people have when considering having an aesthetic procedure. And, when opioids are out of the question – whether it’s because of allergies, a history of addiction, or simply personal preference – the prospect of invasive surgery or treatment can feel even more daunting. The good news is that there are several options for non-opioid anesthesia and pain relief. These alternatives mean cosmetic surgery can be accessible to people for whom opioid-based treatments aren’t a possibility.
We already started to explore the future of opioid use in aesthetic medicine, and now it’s time to continue the deep dive. We’re exploring what opioid-free surgery and recovery looks like, what other options exist for sedation and pain relief, and how these alternatives may affect your levels of comfort during and after a procedure. Plus, two patients who have undergone treatments using opioid-free medications share their experiences in an effort to reassure others in a similar situation.
What Are Opioids?
Opioids refer to a class of drugs found naturally in the opium poppy plant or synthetic compounds. They are most often used in medicine to relieve pain (including via anesthesia) by interacting with opioid receptors in your brain. This is why they commonly are prescribed to treat discomfort after surgery.
When used safely and in moderation, opioid medications can be a helpful resource to maintain comfort levels after surgery. However, at higher doses, they can cause drowsiness and even slow down breathing or heart rate. Some people feel a sense of relief or even joy after taking opioids, which makes the drug susceptible to becoming addictive.
For those who have overcome opioid addiction or who are allergic to the category, finding alternative pain relief is vital. Being upfront and honest with your plastic surgeon and anesthesiologist will allow them to create a plan that will be safe and effective for your needs. In the case of prior addiction, it may also be worthwhile to discuss your thoughts about having surgery with a counselor or therapist, who will be able to help you decide if you’re at the right stage of recovery to undergo a procedure.
What Options Exist for Opioid-Free Anesthesia?
If you need to have opioid-free surgery, you will need to discuss this with your surgical team early on in the consultation process. Many cosmetic procedures can be performed using anesthesia that is suitable for people who cannot use opioids. These include breast surgery (reduction and augmentation), liposuction, tummy tucks, facelifts, and more. In essence, the need to avoid opioids does not necessarily limit the types of procedures you can access.
One of the ways surgical teams can operate without using products that contain opioids is by using a method known as total intravenous anesthesia (TIVA). TIVA is an anesthetic that generally allows people to go home on the same day as their surgery with minimal discomfort. Unlike more common forms of anesthesia that can combine the use of gaseous anesthetics delivered via vaporizers and intravenous drugs, TIVA only uses intravenous drugs. When you are sedated for the procedure, your anesthesiologist will place an IV, usually in your arm, and you will start to feel sleepy shortly thereafter.
How Can You Manage Post-Op Pain Without Opioids?
Postoperatively, there are several opioid-free pain relief methods that can help you remain comfortable during the first few days after surgery when pain is most common. One of the most widely used products is a long-acting local anesthetic called Exparel®. It acts over several days to numb the area operated on to help lessen your need for further pain relief medication. Exparel®, or bupivacaine, isn’t a narcotic or an opioid, so it is generally seen as a good option for patients with specific medication-related concerns.
Regardless of how you will be managing your pain post-op, your surgical team will provide you with a plan to stick to when you return home. It will include details of medications you can safely take, the timing, and the dosage. Following this plan is the best way to achieve as smooth and comfortable a recovery as possible. If, for any reason, your pain levels don’t decrease as planned or are getting worse, it’s always a good idea to get in touch with your surgeon or their team to ensure everything is healing as planned.
How Do Non-Opioid Alternatives Affect Recovery?
Researchers have found that post-op pain levels may be slightly higher for patients who receive TIVA. However, these can be mitigated by the use of Exparel® or similar products. With any surgery, there is a likelihood that you will feel uncomfortable, especially in the first couple of days. After that time, your pain levels should subside as the body heals. Even for patients who are prescribed opioids for pain relief, it is typically only for that initial downtime period. After that, most switch over to over-the-counter remedies. We’ve said it before and we’ll say it again, following your surgeon’s suggested recovery plan to a T and proactively flagging anything that seems abnormal is the key to a safe and successful recovery.
Sharing details of a past addiction with a healthcare provider can feel overwhelming, so we’ve spoken to two patients who have done just that. Here, they candidly open up about their experience having cosmetic procedures after recovering from opioid addiction and how they managed their pain during recovery.
JP, 38, Palm Springs, CA
JP recovered from an addiction several years before considering liposuction. After discussing the procedure with a friend who had gone through similar difficulties, he decided to go over the idea with his therapist before making appointments with surgeons.
The AEDITION: How did you approach sharing your past addiction with your surgeon?
JP: This was something I was very nervous about, despite knowing that it’s a topic they likely see come up frequently. I prepared for my consultations by making a list with my therapist, so I could be sure to cover everything without feeling overly uncomfortable. It’s an awkward topic for me anyway, but we worked to make sure it would go as smoothly as it could. Then, when I booked the appointments, I let them know in my first email that having an opioid-free procedure was vital and that I was anxious about discussing it. The surgeon I ended up working with actually helped me get the subject out of the way right off the bat, so we had ‘the talk’ and then spoke about the procedure. He made me feel at ease and explained the alternative options available to me.
The AEDITION: How did your recovery go?
JP: I had read many articles about what to expect after my procedure, so I had in mind what to expect. I can’t say that my recovery seemed different from that of any of the people whose experiences I had read about. I was convinced I would be in a lot of pain – not because of any evidence-based research, I just had this preconceived idea – but the whole experience went very smoothly.
The AEDITION: Do you have any advice for people who have overcome addiction considering a cosmetic procedure?
JP: The main factor is going into it at the right point in your recovery. If I had gone into that setting a few years earlier, I think the outcome could have been different. I’m grateful I gave myself time. I would also recommend trying to set the feeling of shame aside and focusing on advocating for your needs. Surgeons and anesthesiologists are there to help their patients, and it’s ok to ask for your needs to be met.
Alice, 54, New York, NY
Alice had wanted to have a breast lift for as long as she could remember. After discussing her concerns with a friend who happened to be a doctor, she found she may be able to have the procedure without opioids.
The AEDITION: How did you came to learn about opioid-free surgical options?
Alice: I have a good friend whose husband is a doctor. We were talking about celebrities having cosmetic surgery, and I happened to drop into the conversation that I wouldn’t be able to have anything done even if I wanted to because of my past troubles with addiction. He half-jokingly told me that there are plenty of alternative medications that could be used. I didn’t discuss it much more with them, but the idea stuck with me. I did my research before finding a surgeon who used these methods in their practice.
The AEDITION: How were your comfort levels during recovery?
Alice: I was told to expect to be uncomfortable for the first three days after my procedure, and, indeed, it was not great. However, I was able to take the medication the doctor prescribed to me, and it took the edge off the pain. I was able to sleep and get the rest I needed to heal well. After around four or five days, I started to see improvements. I felt less like I was simply waiting between two doses of painkillers.
The AEDITION: Do you have any advice for people considering surgery with TIVA?
Alice: Doing your own research and finding a sympathetic surgeon would be the two key takeaways for me. I found it helpful to go into a consultation with a clear idea of what I would like to hear from the surgeon in terms of their suggestions for alternative pain relief and anesthesia and their experience in dealing with patients who had similar factors to consider. Finding the right team to surround yourself with makes the process more straightforward. It is vital to tell loved ones about your plans and ask for their support. It certainly was in my case.
It is increasingly common for cosmetic surgery patients to seek out opioid-free procedures and recovery for a variety of reasons. There are also an ever-increasing number of pain management options for such patients. Honestly sharing your medical history and preferences with prospective surgeons from the beginning is the best way to ensure a safe and effective procedure and recovery plan.
If you or someone you know is struggling with substance abuse or recovering from an opioid addiction, the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline offers free and confidential help 24 hours a day, seven days a week. It can be reached at 1-800-662-4357.
*Patient names have been changed
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