Pain relief after major 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.
Intravenous (IV) pain medication
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 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.
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.
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:
- 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.
Your role in pain control
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.
June 30, 2017
- Be honest about the pain you feel after surgery. Let your doctors and nurses know how much it hurts, where it hurts, and what activities or positions make it better or worse. Your health care team will want to know the intensity of pain on a 0 to 10 scale, where 0 is no pain and 10 is the worst pain you can imagine. The more specific you can be, the better your doctors can help you.
- Don't ignore side effects. Tell your care team if you experience sleepiness, constipation, nausea or other side effects of the medications. A different pain medication or dose can sometimes reduce uncomfortable side effects, and these side effects can often be treated and relieved.
- Lovich-Sapola J, et al. Postoperative pain control. Surgical Clinics of North America. 2015;95:301.
- Mariano ER. Management of acute perioperative pain. http://www.uptodate.com/home. Accessed Nov. 29, 2016.
- What to ask your doctor before taking opioids. U.S. Food and Drug Administration. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm529517.htm. Accessed Nov. 29, 2016.
- A guide to safe use of pain medication. U.S. Food and Drug Administration. http://www.fda.gov/forconsumers/consumerupdates/ucm095673.htm. Accessed Nov. 29, 2016.
- McMahon SB, et al., eds. Posteroperative pain and its management. In: Wall and Melzack's Textbook of Pain. 6th ed. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.clinicalkey.com. Accessed Nov. 29, 2016.
- Wu CL, et al. Treatment of acute postoperative pain. The Lancet. 2011;377:2215.
- Argoff CE. Recent management advances in acute postoperative pain. Pain Practice. 2014;14:477.
- Dowell D, et al. CDC guideline for prescribing opioids for chronic pain — United States, 2016. MMWR Recommendations and Reports. 2016;65:1.
- Guideline information for patients: Safe, more effective pain management. U.S. Food and Drug Administration. http://www.cdc.gov/drugoverdose/prescribing/patients.html. Accessed Nov. 29, 2016.
- About opioids. Turn the Tide Rx, Office of the U.S. Surgeon General. http://turnthetiderx.org/for-patients/#. Accessed Jan. 19, 2017.
- Treatment options. Turn the Tide Rx. Office of the U.S. Surgeon General. http://turnthetiderx.org/treatment/#. Accessed Jan. 19, 2017.