Pain Relief Before and After Surgery

Pain relief is an important part of your overall care before, during, and after surgery. You and your health care provider will work together to make a plan to manage any pain that you have before surgery (preoperative) and after surgery (postoperative). Addressing pain before surgery lessens the pain that you will have after surgery.

Make sure that you fully understand and agree with your pain relief plan. If you have questions or concerns, it is important to discuss them with your health care provider.

If you have pain that is not controlled by medicine, tell your health care provider. Severe pain after surgery may:

• Prevent sleep.
• Decrease your ability to breathe deeply and to cough. This can result in pneumonia or upper airway infections.
• Cause your heart to beat more quickly.
• Cause your blood pressure to be higher.
• Increase your risk for stomach and digestive problems.
• Slow down wound healing.
• Lead to depression, anxiety, and feelings of helplessness.

Your health care provider may use more than one method at a time to help relieve your pain. Using this approach may allow you to eat, move around, and possibly leave the hospital sooner.

What are options for managing pain before and after surgery?

Oral pain medicines

Pain medicines taken by mouth (orally) include:

• Non-narcotic medicines:
  • Acetaminophen.
  • NSAIDs, such as ibuprofen and naproxen.
• Muscle relaxants. These may relieve pain caused by muscle spasms.
• Anticonvulsants. These medicines are usually used to treat seizures. They may help to lessen nerve pain.
• Opioids. These medicines relieve pain by binding to pain receptors in the brain and spinal cord (narcotic pain medicines). Opioids may help relieve short-term (acute) postoperative pain that is moderate to moderately severe.
  • Opioids are often combined with non-narcotic medicines to improve pain relief, lower the risk of side effects, and lower the chance of addiction.
  • Some common side effects of opioids include constipation, nausea, and excessive sleepiness.
  • To help prevent addiction, opioids are given for short periods of time in careful doses. If you follow instructions from your health care provider and you do not have a history of substance abuse, your risk of becoming addicted to opioids is low.

Some of these medicines may be available in injectable form. They may be given through an IV if you are unable to eat or drink.

As-needed pain control

You can receive pain medicine when you need it, through an IV or as a pill or liquid. When you tell your health care provider that you are having pain, he or she will give you the proper pain medicine.

Medicine that numbs an area

You may be given pain medicine that numbs an area. This is called a local anesthetic. It may be given:

• As an injection near your painful area (local infiltration).
• As an injection near the nerve that provides feeling to a specific part of your body (peripheral nerve block).
• As an injection in your spine (spinal block).
• Through a local anesthetic reservoir pump. For this method, one or more small, thin tubes (catheters) are inserted into your incision at the end of your procedure. These catheters are connected to a device that is filled with a non-narcotic pain medicine. Medicine gradually empties into your incision area over the next several days.

Continuous epidural pain control

With this method, you receive pain medicine through a catheter that is inserted into your back, near your spinal cord. Medicine flows through the catheter to lessen pain in areas of your body that are below the catheter. The catheter is usually put into the back shortly before surgery. It may be left in until you can eat, take medicine by mouth, pass urine, and have a bowel movement.

This method may be recommended if you are having surgery on your abdomen, hip area, or legs. This method of pain relief may help you heal faster because you may be able to do these things sooner:

• Regain normal bowel and bladder function.
• Return to eating.
• Get up and walk.

IV patient-controlled analgesia (PCA) pump

With this method, you receive pain medicine through an IV that is connected to a PCA pump. The PCA pump gives you a specific amount of medicine when you push a button. This lets you control how much medicine you receive. You are the only person who should push this button. The pump is set up so that you cannot accidentally give yourself too much medicine.

You will be able to start using your PCA pump in the recovery room after your procedure. Tell your health care provider:

• If you are having too much pain.
• If you cannot push the button.
• If you are feeling too sleepy or nauseous.

Other pain control methods

Other methods of pain relief after surgery include:

• Heat and cold therapy.
• Massage.
• Topical analgesics. These are patches, creams, and gels that can be applied on the skin.
• Steroid medicines. These medicines may be given to lessen swelling.
• Physical therapy. A physical therapist will work with you to meet goals, such as feeling and functioning better. Physical therapy usually includes specific exercises that are tailored to your needs.
• Transcutaneous electrical nerve stimulation (TENS). This method sends electrical signals through the skin to interrupt pain signals.
• Cognitive behavioral therapy (CBT). This therapy helps you learn coping skills for dealing with pain.

What are some questions to ask my health care provider?

• What pain relief options would be best for me?
• What are the risks of each option?
• What are the benefits of each option?
• How long will I need pain relief after surgery?

Summary

• A plan to manage pain that you may have before surgery (preoperative) and after surgery (postoperative) is an important part of your overall care.
• Pain management options include medicines and nonmedical therapies, such as physical therapy, massage, and heat or cold therapy.
• Pain management medicines include opioids and non-narcotic medicines such as NSAIDs, steroids, or local anesthetics.
• Pain medicines can have side effects. Side effects of opioids include constipation, nausea, excessive sleepiness, and risk of addiction. Your health care provider will work with you to prevent or manage these side effects and risks.