Postoperative pain relief
Pain that occurs after surgery is an important concern. Before your surgery took place, you may have discussed with your surgeon about how much pain you should expect and how it will be managed.
Several factors determine how much pain you have and how easy it is for you to manage it.
- Different types of surgeries and surgical cuts (incisions) produce different types and amounts of pain afterward.
- A longer and more invasive surgery, besides causing more pain, can "take more out of you." Recovering from these other effects of surgery can make it harder to deal with the pain.
- Each person feels and reacts to pain differently.
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 so that you go 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 medicine or a combination of medicines.
Studies show that patients who use pain medicine after surgery to control pain often use fewer pain medicines than those who try to avoid pain medicine.
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. Doctors and nurses will always be busy, but do not worry about bothering them. Speak up. In the end, your are the one who is in control of your pain.
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. The pump is 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. It is programmed so you cannot give yourself too much.
Epidural Pain Control
Epidural pain medicines are delivered through a soft tube (catheter). The tube 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 out of surgery with this catheter already in place. Or a doctor inserts the catheter into your lower back while you lay on your side in the hospital bed.
Risks of epidural blocks are rare but may include:
- Drop in blood pressure. Fluids are given through a vein (IV) to help keep your blood pressure stable.
- Headache, dizziness, difficulty breathing, or seizure.
Pain Pills or Shots
Narcotic pain medicine taken as pills or given as a shot may provide enough pain relief. You may receive this medicine right away after surgery. More often, you receive it 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 provide relief for 4 to 6 hours or longer. 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
American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012;116:248-273.
Hurley RW, Wu CL. Acute postoperative pain. In: Miller RD, Eriksson LI, Fleisher LA, et al., eds. Miller's Anesthesia. 7th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2009:chap 87.
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: Elsevier Saunders; 2012:chap 16.