Pain control is an incredibly important part of recovering from surgery, both at the hospital and at home or in rehab. In my previous post, I explained the members of the healthcare team who are involved in pain management. Here, I’ll discuss some of the tools they use for managing pain.
Pain Management Used To Numb Specific Body Parts
Local anesthetics: Local anesthetics are often used for small procedures because they make a small area of skin numb. They can be given with a shot under the skin or as a lotion applied to the skin. When given as a shot, local anesthetics sting a bit (like a bee sting) before they make the area numb.
Some patients say that they can feel pressure after the area is numb, but pain should be eliminated as long as the local anesthetic is working. The skin can stay numb from minutes to hours, depending on the exact medication used. Surgeons will also frequently use local anesthetic at the end of an operation, even if the patient is asleep, to provide some pain relief for when the patient wakes up. Surgeons often use local anesthetic that way because the pain of an operation, like any sort of injury, tends to be more intense in the first few hours.
Regional anesthetics: Local anesthetics work by blocking nerve function. So, when the same medications used as local anesthetics are delivered to the larger nerves that feed a whole part of the body, big parts of the body can all be made numb at once. For example, when surgeons inject anesthetics around the nerves feeding a leg, the whole leg can be made numb. These regional nerve blocks allow for larger operations than what local anesthetics would allow.
Spinal/Epidural: If nerves are blocked within the spine, even larger areas of the body can be made numb than is possible with regional anesthesia. The best-known example of these anesthetics is the epidurals used for childbirth. However, by changing the type of medication and the portion of the spine exposed, spinal and epidural anesthetics can be tailored to provide numbness in any area between the chest and the toes. (The difference between spinal and epidural anesthetics has to do with which layer of the spinal column the medication goes into and is beyond the scope of this post.) Because there are some serious risks associated with injecting anesthetics into the spinal column, only anesthesiologists perform and manage this kind of pain control.
Pain Management Used To Provide Pain Relief throughout the Whole Body
Intravenous (IV) Pain Medication
IV pain medicine is delivered directly into a patient's vein. Most of these medications are narcotics, such as morphine and hydromorphone, but there are also some IV forms of non-narcotic pain medications, such as ketorolac, which is similar to ibuprofen, and even IV acetaminophen (such as Tylenol). The advantage of IV pain medication is that it works quickly and can be delivered to patients who aren't able to swallow pills. The disadvantage of IV pain medication is that it generally doesn't last as long as pill forms of medication, and it can have more side effects. Generally, once patients can take pain medication by mouth, it's the better option.
IV pain medications can be delivered by nurses (which is known as bolus dosing) or by a patient-controlled analgesia (PCA) machine. These machines are at the bedside, and the patient can press a button to request a pain medication dose and receive smaller doses more frequently than what nurses can provide. Talk to your surgery team about which option makes the most sense for you.
Oral Pain Medication
Oral pain medications are tablets or liquid pain medicine that can be swallowed or put in a feeding tube. Like IV pain medications, there are both narcotic (oxycodone and hydromorphone are probably the most common) and non-narcotic (ibuprofen, acetaminophen) oral pain medications. There are also mixtures of the two (Percocet, for example, contains both oxycodone and acetaminophen). Oral medications typically provide better long-term pain relief, but can be hard on the stomach and intestines, so are generally not used until patients are able to eat.
All narcotic pain medications have the side effect of causing serious constipation, so be sure to talk to your surgery team to be sure they provide stool softeners along with narcotic pain medications. Also, try to stay hydrated and eat high-fiber foods while taking narcotics.
Other Pain Control Measures
Beyond pain medications, there are several other methods to reduce pain associated with surgery. Ice packs can help reduce the pain around incisions during the first couple of days after an operation. Be sure to check with your surgery team before using them.
Creating distractions during uncomfortable procedures, such as dressing changes, can also be a great help in reducing pain. Talking to a loved one, watching a television program, listening to music, or just taking slow, deliberate breaths can all reduce pain. It's also a great idea to take pain medicine 15-30 minutes before doing something you know will be painful, since it's much easier for pain medicines to prevent pain than to eliminate pain that's already present.
Often anxiety can contribute to pain. If simple distraction doesn't work, talk to your surgery team about anti-anxiety medications. Some of these medications have bad interactions with narcotic pain medicines, but there are many strategies to reduce anxiety that your team can provide if you ask.
Remember that no pain medicine can make you completely pain free from surgery, but by working with your anesthesiologists and your surgical team, your pain should be manageable after any operation.
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