A Patient s Guide to PAIN MANAGEMENT. After Surgery

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1 A Patient s Guide to PAIN MANAGEMENT After Surgery C o m p a s s i o n a n d C o m m i t m e n t

2 A Patient s Guide to Pain Management After Surgery If you re facing an upcoming surgery, it s natural to worry about the pain you will feel afterward. While you can expect some pain, it should never be overly severe or intolerable. Modern medicine provides many ways of treating postsurgical pain depending on the type of surgery and your personal needs and preferences. This guide is to inform you of your options for pain treatment following surgery. It also provides steps for how you can help medical staff safely minimize your pain. At Kingman Regional Medical Center, we consider effective pain management a critical part of your recovery. This is because well-controlled pain will speed your healing and lead to fewer complications. After your surgery, our healthcare team will observe how you respond to pain treatment and will make necessary adjustments to keep you as comfortable as possible. Kingman Regional Medical Center

3 Planning for Pain Management Before the Surgery It s important to plan ahead with your doctor on the best methods for controlling your pain after the surgery. When talking with your doctor, make sure you discuss What to expect after the surgery Ask your doctor to explain the operation and what kind of pain you can expect afterwards. For example, ask if it will hurt when you cough or get out of bed. Also, ask about the specific measures your doctor plans to take to control your post-surgical pain. Knowing what to expect ahead of time can help reduce anxiety (and pain) after the surgery. Previous experiences with pain and pain control Tell your doctor about what types of pain control have worked for you in the past and what didn t. Make sure to mention any and all instances where you experienced an adverse reaction to a pain medication or treatment. Alcohol and drug use Be honest with your doctor about your alcohol and drug use. If you currently abuse alcohol or drugs, the post-surgical period is not the time to go through withdrawal. Also, tell your doctor if you are recovering from an alcohol or drug addiction. Your doctor can plan for pain control that will lessen your risk of a relapse. Current medications List all supplements, herbs, prescription and over-thecounter medications you ve taken in the past month. Many substances can interact with the anesthesia during surgery or pain medications after surgery. Also, tell your doctor about any pain medications you take on a regular basis. Your body may have developed a tolerance to their effects, which could require higher than usual doses to achieve adequate pain control. Even if you re not a heavy drinker, alcohol can have an adverse effect with some pain medications. Be sure to talk to your doctor about any concerns you have. Pain Management After Surgery

4 Pain Management After the Surgery After surgery, your doctors and nurses will work to keep you as pain-free and comfortable as possible. This is important so that you can complete important tasks toward your recovery, such as walking and deep-breathing exercises. These tasks are vital for reducing your risk of certain complications, such as blood clots and pneumonia. Pain is personal. The amount or type of pain you feel may not be the same as what others feel even those who have had the same operation. Since everyone s experience with pain is different, it is extremely important to communicate the following to your healthcare team: When it hurts If you re having pain, please tell someone! When your pain is under control, your body can focus on the important work of healing. So this isn t the time to test your pain tolerance or to try to just suffer through it. While in the hospital, never hesitate to use your call button to summon a nurse for immediate help. If you are experiencing intense pain after you go home, call your doctor. Where it hurts You may be surprised at where you ll experience pain. It is common to hurt in areas not related to the surgery site. For example, you may feel muscle pain in the neck, shoulders, back, or chest from laying on the operating table or your throat could feel sore or scratchy after having a breathing tube. Tell your nurse or doctor about all areas where you are experiencing pain. How much it hurts Only you can tell the level of your pain, so your nurses and doctors will often ask you to rate your pain on a scale of 0-10, with 0 meaning no pain and 10 meaning the worst pain you can imagine. Never downplay the pain be as specific as you can in describing how you feel. This will help your healthcare team control your pain and assess which measures are most effective in keeping you comfortable. If you are experiencing uncomfortable side-effects Tell your nurse or doctor if you are overly sleepy, constipated, nauseated, or experiencing other side-effects from the pain medications. Often, your doctor can order a different medication or dose to alleviate unpleasant side effects. Kingman Regional Medical Center

5 Common Pain Management Options Depending on your needs and the type of surgery you are having, different options for relieving pain are available. If you undergo major surgery (chest or abdominal surgery, joint replacement, etc.), you will first require more intense efforts to relieve pain but will eventually move to less-powerful oral medications by the time you go home. For minor operations, you will probably start with moderate pain treatment. The following pain control options are listed from the most to least powerful: Epidural analgesia You may be familiar with this form of pain relief because it is often used to control pain during labor and childbirth, but it is also commonly used for major surgeries. In epidural analgesia, medications are injected through a thin tube (called a catheter) that is placed into your back. Placing the epidural catheter usually causes no more discomfort than having an IV started. The catheter is often inserted shortly before a major operation and left in place for several days. A continuous infusion of pain relievers including numbing medications (local anesthetic) and opioid medications (e.g., morphine) can be delivered through the catheter to eliminate pain from the neck down. Patients who receive epidural analgesia typically have less pain when they take deep breaths or cough. Neuraxial opioids Unlike epidural analgesia, this form of pain relief involves medications injected directly into the spinal fluid. This is common for Caesarean section and many urological procedures. A long-acting opioid can also be added to the spinal medication to relieve post-surgical pain for up to 24 hours. Nerve blocks Nerve blocks prevent pain messages from traveling up the nerve pathway to your brain. Unlike an epidural that controls The most powerful pain management medications are pain over a broad area of your body, administered by injection or intravenous infusion. nerve blocks affect a smaller region, Pain Management After Surgery

6 such as an arm, leg, hip, or shoulder. A single injection around the appropriate nerves will provide a few hours of relief. For longer pain relief, nerve blocks can be delivered through a catheter into the affected area. Nerve blocks can be used for outpatient procedures or more involved inpatient surgery. This form of pain control can be advantageous because it can reduce the amount of opioid medications you may need, which can result in fewer side effects such as nausea, vomiting, itching, and drowsiness. Intravenous (IV) pain medications Before surgery, you ll probably have a slender plastic tube inserted into a vein in your hand or arm to give you fluids, anesthetics, antibiotics, or pain medications. After surgery, your doctor may keep this intravenous catheter in place to deliver pain medications while you re in the hospital or outpatient recovery room. Pain relievers, such as opioids, are usually injected into your IV at regular intervals. Patient-controlled analgesia KRMC offers patient-controlled analgesia (PCA), which is a system that allows you to give yourself a fixed dose of pain medication by pushing a button. 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 your request. This gives each dose of pain medicine enough time to work before you receive another dose. Also, when there s more medication than you need in your bloodstream, you become too sleepy to press the button. When you re no longer drowsy from medication, you ll be able to safely give yourself another dose. That s why you should never press the PCA button for a sleeping friend or family member. No one but the person receiving the medication should ever administer a dose. Local anesthetics Your doctor may inject local anesthesia directly into a wound or surgical incision, using a very small needle. This numbing medication blocks pain in a small area of the body, so it s often used for minor procedures. This form of pain relief doesn t last long, but it can help reduce the need for other pain medications. It s also possible to go home with a catheter that delivers local anesthetics. Kingman Regional Medical Center

7 Oral Medications Once you re able to eat regularly, you ll probably start oral pain medications in the hospital and continue taking them during your first few days or weeks at home. Depending on your pain medication needs, oral medications can include any of the following. Opioids (Percocet, Vicodin, Darvocet, Tylenol #3, etc.), effective for moderate to severe pain. Opioids (also known as narcotics) can come with side effects, including drowsiness, nausea, and constipation. Despite common myths, opioids have a low risk of addiction when taken exactly as directed over a relatively short period of time. Non-narcotic analgesics (Tylenol, Feverall ), for mild to moderate pain. These often decrease the need for stronger medications, which may reduce the incidence of side effects however, it is important to never exceed the recommended daily dose, as liver damage may result. Patients with pre-existing liver disease or those who drink significant quantities of alcohol may be at increased risk of liver damage. Nonsteroidal anti-inflammatory drugs (Advil, Motrin, Aleve, Celebrex, or generic ibuprofen) can reduce swelling, soreness, and minor pain. They may be combined with opioids for treatment after some arthroscopic surgeries or home recovery after major surgery. Combining anti-inflammatory drugs with opioids maximizes pain relief with lower doses of opioid medications, which causes fewer side effects. In addition to conventional medications, practices such as guided imagery or meditation can help with pain management. Pain Management After Surgery

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