One of my geeky interests is emerging technology. When this overlaps with Plastic Surgery all the better. Like I got into a little bit before (with my rant on what I thought was revolutionary vs. obsolete or dead-end the other day), we're in an era where we're bombarded with products, each claiming to have built a better mousetrap. Be it skin care products, the newest laser, or some 'magic' surgical technique or device to facilitate surgery everyone is trying to sell you something. In most cases you see that the results are modest & the costs are significant.

There's a big niche waiting to be filled in Plastic Surgery as I see it. As more and more procedures are done as an outpatient (increasingly in an office OR suite), things that can facilitate an easier recovery or lower cost for surgery are going to find a place in the market. Post-operative pain control and nausea prevention are two of the single biggest fears patients report on surveys when they're considering having surgery done.

I'm still a believer in pulsed magnetic field tech. for post-operative pain control in Plastic Surgery. A recent presentation studying the Ivivi device in Europe showed 80% acceleration in pain relief in breast augmentation patients treated with the active PEMF technology as compared to patients treated with placebo units. Another paper presented at a Neurology meeting showed improved nerve cell survival in a standard animal cell model of brain inflammation which is used to test treatments for diseases like Parkinson's, Alzheimer's, Lou Gerhig's disease, and other neuro-degenerative disorders.

Another real interesting thing out there is a drug called Emend (aprepitant). It's a new anti-nausea medicine that works different from other medications in that it actually blocks receptors in your brain that mediate the nausea response on a biochemical level. It must be given prior to anesthesia and is very effective (apparently) at preventing post-operative nausea and vomiting (PONV) for 48-72 hours. This drug is being used mostly for chemotherapy patients currently, but the potential for use in the outpatient Plastic Surgery patient group is obvious.

What's the catch with Emend? Well, currently it runs in excess of $80 per pill for a single dose. Merck received an approvable letter from the FDA in May so expect to see this promoted more and the price to slowly drift down. If it works as advertised, I bet it becomes routinely used preoperatively for many surgeries just as Zofran has been.



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