How We Reduce Pain After Plastic Surgery with the ERAS Protocol

When someone has plastic surgery, whether it’s a cosmetic surgery, breast reconstruction after breast cancer surgery, or a hernia repair, one of their first concerns typically is how much pain they will experience after surgery.

This is something we take seriously at MedStar Washington Hospital Center. In fact, we follow the Enhanced Recovery After Surgery (ERAS) protocol, which is when our medical team works together with patients prior to surgery to learn about their pain tolerance and medical history to create care plans that result in:

• Minimized pain after surgery
• Quicker recoveries
• Reduced narcotic usage

We saw one patient who previously had more than six hernia surgeries, and her most recent one required a two-week hospital stay, some of which was in the intensive care unit (ICU). When she saw us for another surgery to treat her hernia, as a plastic surgeon, I spoke with her to learn how she tolerated her previous surgeries and worked with anesthesiologists and general surgeons to devise a care plan that minimized the invasiveness of her surgery and decreased the amount of pain she experienced afterward. She ended up walking the day after surgery and said that it was the best she’d ever felt compared to her previous surgeries.

LISTEN: Dr. Fan discusses reducing pain after plastic surgery in the Medical Intel podcast.

How Does the ERAS Protocol Work?

The benefit of doctors using the ERAS protocol, which was first introduced to MedStar Washington Hospital Center by Dr. Susan Dumsha Stasiewicz and later was incorporated into the care plans that other MedStar entities offer, is that it always results in faster recoveries—although recoveries still can vary depending on the type of procedure patients undergo. For example, some surgeries result in very little pain and allow individuals to go home the same day, while more invasive surgeries can require people to stay at the hospital overnight for one to four days because their pain is more severe.

Below is how we approach managing pain with the ERAS protocol before, during, and after surgery.

Before Surgery

The first and most important step of the ERAS protocol is to set the expectation of pain, which is important since not all patients perceive pain the same way. We set pain expectations through a preoperative assessment of patients in which we discuss how they:

• Generally tolerate pain
• Recovered from previous surgeries
• See themselves recovering from this particular surgery

Once we have pain expectations set, we provide patients with a cocktail of non-opioid medications that target the way their nerves fire. Make sure to speak to your doctor to learn about the different medication options and which might work best for you.

During and After Surgery

During plastic surgery, we provide patients medications that reduce nausea and vomiting, as well as a local anesthesia, or a technique used to eliminate pain from the area of the body in which you’re having surgery by numbing it and blocking the nerves associated with the area from activating.

After surgery, we use medications similar to the ones patients received prior to surgery to reduce their pain by continuing to keep the nerves associated with the surgical site from firing as strongly. Because pain tolerance varies from person to person, consistent communication between a patient and their doctor is key to successfully managing the patient’s pain after surgery. This is done through both follow-up appointments and patients calling the doctor’s office when needed.

How We Reduce the Use of Narcotics

Opioid use has reached a tipping point in America, as it’s now considered a health emergency. Every day, more than 130 Americans die after overdosing on opioids. As a result, through the ERAS protocol, we avoid prescribing opioids to patients unless we feel it’s entirely necessary based on our initial conversations regarding their pain tolerance. We do this by managing pain in other ways, such as through local anesthesia and non-narcotic medication.

If a patient and their doctor decide that taking opioids is necessary for pain tolerance after plastic surgery, it’s important to understand possible side effects and the correct dosage they should take. Speak to your doctor if you’re unclear about anything related to your prescribed medications.

Although pain is a part of any plastic surgery, we have significantly reduced the amount of pain patients experience throughout the years with our ERAS protocol. Before your plastic surgery, make sure you and your doctor have a plan in place to help you effectively manage your pain after the procedure.