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Postoperative Pain Management

Postoperative pain management actually begins preoperatively. Your anesthesiologist and surgeon will decide on a plan prior to your surgery. A major deciding factor with regard to choosing an appropriate plan will depend on whether the patient is to be discharged the same day (day surgery) or will be admitted after surgery.

The following techniques may be used to treat postoperative pain.

PCA (Patient Controlled Analgesia)
This device allows patients to control their own pain relief immediately. Using a push button connected to a small programmable pump, a patient causes the release of pain medicine into his/her intravenous (IV). Within 2-5 minutes, the patient will experience relief. The pump can also be programmed to provide a continuous infusion of pain medicine as well (this may actually reduce the number of pushes on the button).

Is it safe? Most studies show patients actually use less medication compared to having a nurse deliver the injection. Because the patient can treat pain as it starts to increase, the pain should never get out of control. Significant delays can occur if the patient has to call the nurse, explain that he/she is in pain, and have the nurse retrieve and then administer the pain medication. The longer the delay, the more pain increases and therefore more pain medicine may be required. PCA avoids this delay.

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Epidural Analgesia
An epidural involves the continuous delivery of pain-relieving medication to nerves within the epidural space of the spinal column. Preoperatively, a small catheter is placed and secured to the patient's back. The catheter is then connected to a small programmable pump that delivers continuous pain medication.

The advantages to epidural analgesia are: less sedation, improved pain relief, decreased risk of blood clots (in some patients), and decreased risk of ileus (slowing down of the stomach and intestines). Disadvantages are headache (risk less than 1 in 200) and numbness of the lower extremities (not common).

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PCEA
This option is planned initially for obstetrical patients and should be available for postoperative pain relief by 2004.

PCEA, or Patient Controlled Epidural Anesthesia, combines the PCA and Epidural Analgesia techniques. After the epidural is placed, the catheter is connected to a programmable pump that delivers a continuous infusion of pain relieving medication and allows the patient to self-administer extra medication (a “bolus”).

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Walking Epidural
A walking epidural is an epidural that is used for pain relief. It is often used to describe an epidural for laboring mothers. At SSH, laboring patients are not allowed to walk once an epidural is placed. In fact, at most centers where a "walking epidural" is promoted, patients are discouraged from walking or are not permitted to do so. The reasons for this are numerous.

Walking epidurals are used at SSH following surgical procedures. In most cases, the epidural infusion affects the surgical site and not the legs. These patients are encouraged to walk as it speeds the recovery process.

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Pain Buster
The PainBuster® (dj Orthopedics, LLC) is a system that provides continuous infusion of a local anesthetic directly into the surgical wound. The main advantage to this system is that it can be used in outpatient surgery.

It is generally used for orthopedic procedures and is placed during the operation by the surgeon. It is designed to last approximately 48 hours and can effectively alleviate the moderate to severe pain a patient may experience following many surgical procedures.

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Nerve Blocks
Nerve blocks are used to provide regional anesthesia. In regional analgesia, only a specific area of the body is targeted for pain relief. Each particular nerve block affects a specific area of the body. A nerve block is performed before surgery using a needle to inject local anesthetic around a particular nerve or group of nerves. The result is the affected area is anesthetized.

Nerve blocks are used primarily for postoperative pain relief, but can also be used for surgery. The nerve block therefore may be used in combination with a general anesthetic or sedation. This decision is made preoperatively by the anesthesiologist, surgeon, and patient.

The following are examples of nerve blocks performed by SSAA:

  • ANKLE (anesthetizes the foot)
  • AXILLARY (anesthetizes the arm and hand)
  • CERVICAL PLEXUS (anesthetizes the neck)
  • FEMORAL (anesthetizes the thigh and part of the knee)
  • INTERSCALENE (anesthetizes the shoulder, arm, and hand)
  • POPLITEAL (anesthetizes the lower leg and foot)
  • SCIATIC (anesthetizes the thigh, lower leg, and foot)

Links
For further information regarding epidurals for post-operative pain management, please consult the link below. Keep in mind that practices vary from hospital to hospital and these sites contains general information and should not be relied upon for specific instruction.

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