Most patients will need, want, and receive pain medicine after surgery. All patients will have discomfort after surgery, but this discomfort will be made tolerable. There are many ways to receive medicine for pain after surgery. Narcotics are very potent pain relievers and are appropriate for many patients. Other non-narcotic pain relievers are also sometimes used. Patients receiving spinal or epidural anesthesia will be comfortable without additional medication when they first arrive in the recovery room. As the anesthesia gradually wears off, they too will begin to need pain medicine.

     For patients who are going home on the day of surgery, pain medicine must be given in such away as to make patients comfortable, but allow them to safely make their way home. Patients whose pain can not be controlled with doses of medicine which allow them to safely make their way home, may need to stay in the hospital overnight. Often the surgeon will prescribe oral pain medicine for use at home after surgery. Most often these prescriptions are given to patients and their support person at the time they leave the hospital. Sometimes the surgeon provides these prescriptions ahead of time so that patients can fill them ahead of time.

Dr.  Peress, Laparoscopic Surgery

 

     Patients staying in the hospital overnight, can safely be given stronger pain medication. Pain medicine in the recovery room is prescribed by the anesthesiologist. Most often, this is intravenous narcotic administered by the recovery room nurse according to the patient’s need. This technique allows patients to very rapidly and safely achieve comfort. 

     Narcotics also have side effects. These include sedation, nausea, and vomiting. Because of the sedation, many patients don't remember the recovery room even though they were wake enough to answer questions appropriately. Nausea is often controllable with the use of other medication to suppress it or by switching to another narcotic.

     When patients leave the recovery room, responsibility for their pain medicine shifts from the anesthesiologist to the surgeon. Surgeons generally employ one of three techniques of pain control for their hospitalized patients. The first method involves the injection of narcotic into the buttock. Usually the orders for this medicine are given such that there is a minimum time interval, which must elapse before another injection, is allowed. Also, the patient must request this medicine. This is the traditional method for providing pain relief to hospitalized patients after surgery.

     A second, newer, technique of pain relief allows patients to administer their own narcotic medicine. The technique is called Patient Controlled Analgesia. An ampule of narcotic solution is connected to the patient's intravenous. Between the ampule and the patient is a box connected to a push button device. The box can be programmed for the dose administered when the patient pushes the button. It also is programmed for a lockout interval during which, if the patient pushes the button, he receives no medicine. This device allows the patient to be in control of his pain medicine, and to receive medicine immediately when he pushes the button, rather than waiting for the nurse. The lockout interval prevents overmedication.

epidural copy.JPG (18652 bytes)   epidural catheter

     A third technique of pain relief for hospitalized patients is called epidural analgesia. This technique is most appropriate for patients having total knee replacement, intra-abdominal surgery, and lung surgery. Epidural analgesia is provided by anesthesiologists. At the request of the surgeon, and after discussion with the patient, an epidural catheter is inserted into the patient’s lower back in the operating room prior to the beginning of surgery. An epidural catheter is a small soft long plastic tube. Once in place, and secured with a thin adhesive plastic dressing, it is brought up over the patients shoulder. After surgery, a dilute solution of narcotic and local anesthetic is slowly and continuously infused through this catheter. The catheter may remain in place and the medicine infusing for up to four days after surgery. This technique of pain control often provides the best quality pain relief possible for these surgeries. Side effects include itching, nausea, numbness, especially of the thighs, and weakness in the legs.

Epidural Pump

 

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