Post-Surgical Pain

What is Post-Surgical Pain?

Postsurgical pain is defined as pain lasting more than 3 to 6 months after surgery, and the pain differs in quality and location from pain experienced prior to surgery. A primary goal of pain management after major surgery is for you to awaken relatively comfortable and to experience an uninterrupted transition to pain control, but some discomfort is common and should be anticipated after surgery.

What are the Symptoms?

Following surgery, patients are often surprised by where they feel pain, and often times the site of surgery is not the only area of discomfort. Patients may or may not feel the following:

  • Muscle pain: muscle pain in the neck, shoulders, back, or chest from lying on the operating table.
  • Throat pain: Your throat may feel sore or scratchy.
  • Movement pain: Sitting up, walking, and coughing are all important activities after surgery, but they may cause increased pain at or around the incision site.

What are the Treatments?

Typically, severe pain after surgery can be successfully treated. Modern pain medications and anesthesia can control post-surgical pain and help your body heal.

Post-surgical pain is usually managed with multiple pain-reducing medications (analgesics). The appropriate type, delivery and dose of medications for you depend on the type of surgery and expected recovery, as well as your own needs.

Pain medications include the following:

Opioids, which are powerful pain medications that diminish the perception of pain, include fentanyl, hydromorphone, morphine, oxycodone, oxymorphone and tramadol. Examples of opioids prescribed in pill form after surgery include oxycodone (Oxycontin, Roxicodone, others) and oxycodone with acetaminophen (Percocet, Roxicet, others).

Local anesthetics, such as lidocaine and bupivacaine, cause a short-term loss of sensation at a particular area of the body.

Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as ibuprofen (Advil, Motrin IB, others), naproxen (Aleve, Anaprox, others), celecoxib (Celebrex) or ketorolac — lessen the inflammatory activity that exacerbates pain.

Other nonopioid pain relievers include acetaminophen (Tylenol, others) and ketamine (Ketalar).

Other psychoactive drugs that may be used for treating post-surgical pain include the anti-anxiety medication midazolam or the anticonvulsants gabapentin (Gralise, Horizant, Neurontin) and pregabalin (Lyrica).
Your surgeon will likely prescribe a combination of treatments to control pain, lessen side effects, and enable you to resume activity appropriate for recovery and lower risks associated with opioids.

Intravenous (IV) pain medication
Before surgery, you will likely have a slender plastic tube (catheter) inserted into a vein in your hand or arm to give you fluids, sedatives, anesthetics, antibiotics or pain medications. The catheter can be used for delivering pain medications until you can take pills by mouth.

Pain relievers, such as opioids, are usually injected into your IV catheter at regular intervals. Most hospitals also offer patient controlled analgesia (PCA). PCA is a computerized pump that safely permits you to push a button and deliver small amounts of pain medicine into your IV line. PCA provides stable pain relief in most situations, and many patients like the sense of control they have over their pain management.

The PCA system is programmed to prevent you from overdosing on pain medication. If you push the button more than once within a set period of time, the dispenser ignores the second request.

Epidural analgesia
Epidural analgesia involves the injection of pain medications through a catheter inserted into the epidural space within your spinal canal but outside your spinal fluid. An epidural catheter is frequently used for labor and delivery, and sometimes before an operation, such as cesarean section or major abdominal surgery.

The epidural catheter can be left in place for several days if needed to control postoperative pain. A continuous infusion of pain relievers, including local anesthetics or opioid medications, can be delivered through the catheter to control pain.

Patient controlled epidural analgesia (PCEA), similar to PCA, enables you to give yourself a dose of the pain medication by pushing a button. It, too, has built-in safeguards so that you don’t give yourself too much medication.

Epidural analgesia is usually more effective in relieving pain than intravenous medication. Patients who receive epidural analgesia typically have less pain when they take deep breaths, cough, and walk, and they may recover more quickly.

Spinal anesthesia
Some surgeries can be done with spinal anesthesia, which involves medications injected directly into the spinal fluid.

Spinal anesthesia is easier and faster than epidural analgesia is, but it doesn’t last as long because there’s no catheter to allow the administration of additional medication. Your doctor can add a long-acting opioid to the spinal medication that can relieve post-surgical pain for up to 24 hours.

Nerve block
Unlike an epidural, which controls pain over a broad area of your body, a nerve block uses a local anesthetic to provide targeted pain relief to an area of your body, such as an arm or leg. It prevents pain messages from traveling up the nerve pathway to your brain. Nerve blocks can be used for outpatient procedures or more-involved inpatient surgery.

For pain relief lasting several hours, an injection is used for a nerve block. For longer pain control, a catheter may be inserted for continuous medicine delivery or patient-controlled delivery.

One advantage of using a nerve block is that it may allow the amount of opioid (narcotic) medication to be significantly reduced. This may result in fewer side effects, such as nausea, vomiting, itching, and drowsiness.

In some cases, a nerve block can be used as the main anesthetic for your surgery. In this case, you will be given medications during your surgery to keep you sleepy, relaxed, and comfortable. This type of anesthesia provides the added benefit of pain relief both during and after your surgery. It may reduce your risk of nausea and vomiting after surgery. You, your anesthesiologist, and your surgeon will decide before surgery if a nerve block is a suitable pain management or anesthetic option for you.

Wound infiltration anesthesia
Your surgeon may inject an anesthetic drug at the wound site during the procedure or place a catheter for post-surgical drug delivery. This means of local anesthesia may reduce the use of opioids during your recovery.

Pain relief after minor surgery and during home recovery
Your doctor will provide you with instructions for general post-surgical care, such as rest, ice packs, rehabilitative exercises and wound care. Ask to have written instructions to bring home with you.

For minor surgeries these steps may be the primary means for pain management. After major surgery, they will help you with a more comfortable transition off medication.

You will likely switch to oral pain medication before leaving the hospital and continue to take them at home to manage pain. You will probably take a combination of drugs in pill form, which may include the following:

Opioids

  • Acetaminophen
  • NSAIDs, such as ibuprofen and naproxen

As with pain management in the hospital, the combination of drugs that you use at home can result in fewer opioid side effects and lower the risk of opioid dependence.

Be sure to understand what active ingredient is in each pain medication and ask your doctor about possible interactions with over-the-counter drugs you might use, such as cold medicine, or other prescription medications or supplements you regularly take.

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