If you're having surgery, it's natural to have concerns about pain after the procedure, as well as the risks associated with powerful pain medications. Controlling pain and minimizing side effects are both important for post-surgical comfort, recovery and rehabilitation.
The time to talk about post-surgical pain relief and pain medications is before you have surgery. Being prepared can lead to more effective pain management.
Before surgery you will likely have a discussion with your surgeon or other members of your care team about pain management, treatment options and your particular needs. This conversation may include the following ideas:
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:
While opioids may or may not be appropriate to use after your surgery, your surgeon will likely prescribe a combination of treatments to control pain, lessen side effects, enable you to resume activity appropriate for recovery and lower risks associated with opioids.
Opioids are often critical for post-surgical pain management because of their powerful effect. But their side effects can be significant, including nausea, vomiting, constipation, urinary retention, drowsiness, impaired thinking skills and poor respiratory function.
Overdosing and misuse of opioids also are risks, particularly when opioids are used to treat ongoing (chronic) pain. Although the use of opioids after surgery is intended as a short-term strategy to relieve pain while the body heals, the risk of misuse is still a concern.
Because of the risks associated with opioids and their potential side effects, these drugs should be used carefully, if at all. Opioids should be used at the smallest dose effective for the shortest possible time.
You and your doctor should discuss steps you can take to reduce the risks associated with opioid use, including:
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.
Before surgery, you'll probably 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) — a system that allows you to give yourself a fixed dose of the medication by pushing a button. This way you don't have to ask a nurse for each dose of pain medicine.
The PCA system has built-in safeguards 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.
In epidural analgesia, pain medications are injected through a catheter inserted into the epidural space within your spinal canal but outside your spinal fluid. An epidural catheter is often used for labor and delivery, and sometimes before an operation, such as a cesarean section or a 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.
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.
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.
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.
A patient controlled analgesia (PCA) system allows you to give yourself a dose of intravenous pain medicine, with the push of a button. This system decreases any pain and anxiety you may feel while waiting for medicine.
In epidural analgesia, pain relievers are injected into the epidural space, which is within the spinal canal but outside the spinal fluid. A long, thin tube called a catheter (see box), inserted between two vertebrae in the back, delivers the medication.
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 instructions 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 medications 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:
Be sure to understand what active ingredient is in each pain medication, what the appropriate dose is, and how frequently to take your medication. Also 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.
After surgery, work with your health care team to make your recovery as prompt and pain-free as possible. You'll need to communicate with your doctors and nurses to help them assess and adjust the pain management plan.