Pain management or cost management? Which local surgical anesthetic will your hospital use?
I got hurt, literally, by a major not-for-profit "health care system" hospital. I had a double mastectomy with reconstruction. I hurt literally — my pain was poorly and incompletely managed by the hospital because I believe the hospital does not want to provide a more expensive, but longer-lasting local surgical anesthetic – one that is readily available.
The local anesthetic is not a narcotic; I am allergic to most narcotics anyway and the hospital knew this before my surgery. This is about holding off major post-surgery pain for up to three days with a local anesthetic instead of having the worst of the surgical pain begin just an hour or so after the surgery. How? Use a more expensive but longer-lasting local surgical anesthetic. A local anesthetic is similar to what a dentist uses — it merely numbs the affected area and it is not a narcotic.
Several years ago, I had a lumpectomy because of breast cancer. A golf ball-sized lump was removed from my right breast. I had no pain for almost three days afterwards. The area was numb. That was a great thing because the narcotic painkillers I was sent home with made me nauseated. I quickly switched to ibuprofen alone, but I was able to get through it because I was spared the worst of the surgical pain for those first few days. I asked my breast cancer surgeon how she worked this "miracle," and she said it was simply a long-lasting local anesthetic that she regularly uses.
Last year, I broke two bones in my foot. One bone was too shattered for the orthopedic surgeon to fix, but the other one got numerous plates and screws to hold it together and to help it heal correctly. Again, I had no surgical pain for almost three days.
Now I just had a prophylactic double mastectomy with reconstruction at third facility. I did this because, in addition to my previous breast cancer and my mom's death from breast cancer, I recently learned I have a genetic mutation that makes me highly prone to breast cancer. After surgery, I was not expecting overwhelming uncontrolled pain at a major hospital affiliated with a major breast care center. But by the time I was in my hospital room, I was in pain. For three days and nights, I was in agony.
My plastic surgeon informed me that he has tried off and on for years to get the hospital to make the longer-lasting local anesthetic available to him. I also would not want to have been the nurses who cared for me those three nights at the hospital. I remember begging for painkillers every time I was awake because the pain was excruciating. All the narcotics made me loopy, and I did not even remember how to maintain my drains once I got home, though my husband assured me that the nurses had taught us.
My hospital stay was a painful experience. I looked online and found a report of a better experience from an interview with Georgetown University Hospital, anesthesiologist Dr. Joseph Myers: "Called Exparel, it's controversial because it costs more than standard painkillers.” But Myers said it lasts so many hours longer that he recently used it for a cancer patient who had both breasts removed, without resorting to opioids. Hours after surgery, she was, "eating crackers and drinking ginger ale, and she says she's fine..."
I later learned that the local anesthetic used to manage my surgical pain was the short-lived bupivacaine. My surgeon has not been allowed by the hospital to use the much longer-lasting Exparel because it costs more. Exparel is bupivacaine put into a fat suspension that lasts longer because of how it is supplied. It is actually the same medication as bupivacaine, but it stays around longer and isn't metabolized as fast.
Based on my online research, it appears there is a one-time cost difference of approximately $200-$300 between these two local anesthetics. Get my checkbook! I would gladly have paid for it. Breast cancer patients are not livestock. We are humans. Again, I want to point out that Exparel is not an opioid. It is a long-lasting local anesthetic.
If this is the quality of care that a managed health care system gets me, I will do more research next time I need a surgery. I will be making a different hospital choice next time. If this story saves even one person from the three days and nights of the agony that I experienced, I will be glad that I shared it.