Postoperative pain relief
Pain that occurs after surgery is an important issue. Before the surgery took place, you hopefully discussed with your surgeon about how much pain you should expect and how it will be managed.
Several factors can determine how much pain you have and how easy it is for you to manage it.
- Different types of surgeries can produce different types and amounts of pain afterwards.
- A longer and more invasive surgery, besides causing more pain, can "take more out of you." Recovering from these other effects of surgery can also make it harder to deal with the pain.
- We all carry different attitudes and fears about pain. As a result, we feel and react to pain differently.
Besides keeping you as comfortable as possible after surgery, controlling your pain is important for your recovery. Good pain control is needed so you can get up and begin to move around. This is important because:
- It lowers your risk of blood clots in your legs or lungs, as well as lung and urinary infections.
- You will have a shorter hospital stay, getting you home sooner, where you are likely to recover more quickly.
- You are less likely to have lingering chronic pain problems later.
Your Role in Controlling the Pain
There are many types of pain medicines. Depending on the surgery and your overall health, you may receive a single medication or a combination of medications.
Studies show that patients who use pain medication after surgery to control their pain often end up using fewer painkillers overall than those who avoid pain medication.
As a result, your job as a patient is to tell your doctors and nurses when you are having pain and if the medicines you are receiving control your pain. While the nurses and doctors around you will always be busy, do not worry about bothering them. In the end, only you can decide which type of pain relief works best.
Patient Controlled Anesthesia (PCA)
Right after surgery, you may receive pain medicines directly into your veins through an intravenous line (IV). This line runs through a pump that will be set to give you a certain amount of pain medicine.
Often, you can push a button to give yourself more pain relief when you need it. This is called patient controlled anesthesia (PCA) because you are the one who manages how much extra medicine you receive. However, it is programmed so you cannot give yourself too much.
Epidural Pain Control
Epidural pain medicines are delivered through a soft tube (catheter) that is inserted into your back into the small space just outside the spinal cord. The pain medicine can be given to you continuously or in small doses through the tube.
You may come back from surgery with this catheter already in place. Or a specialist physician or anesthesiologist will insert the catheter into your lower back while you lay on your side in your bed.
While rare, some risks associated with epidural blocks include:
- Your blood pressure may drop lower. Fluids are given through a vein (intravenously) to help keep your blood pressure stable.
- You may get a headache, but this is very rare.
- You may have dizziness, difficulty breathing, or a seizure, but these are unusual.
Pain Pills or Shots
Narcotic pain pills taken by mouth or shots given into your muscle may provide enough pain relief. You may have pills or shots right away after surgery. More often, you will receive this medicine when you no longer need epidural or continuous IV medicine.
Ways you receive pills or shots include:
- On a regular schedule, where you do not need to ask for them
- Only when you ask your nurse for them
- Only at certain times, such as when you get up out of bed to walk in the hallway or go to physical therapy
Most pills or shots will provide relief for 4 - 6 hours, or more. If the medicines do not manage your pain well enough, ask your health care provider about:
- Receiving a pill or shot more often
- Receiving a stronger dose
- Changing to a different medicine
Sherwood ER, Williams CG, Prough DS. Anesthesiology principles, pain management, and conscious sedation. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 18.
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