Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. 

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Am Fam Physician. 2001;63(10):1985-1986

How will my pain be managed?

Pain relief after surgery requires teamwork, and the patient is a key member of the team. This team also includes nurses, the surgeon, an anesthesiologist (a doctor who will give you medicine to make you sleep during your surgery) and your family doctor. The first job of this team is to tell you what to expect before, during and after surgery. This helps you reduce stress and this decreases your pain.

Another role for you as a patient is to help the other team members assess your pain. Caregivers rely on you to tell them if you're in pain. One way your doctors and nurses can tell how much pain you feel is to ask you to choose the number from zero to 10 that bests describes your pain, where zero means you have “no pain” and 10 means you have the “worst pain imaginable.”

How are pain medicines given after surgery?

Methods for pain control after surgery depend on the type of surgery you have and your needs. Usually, right after surgery you'll need the most intense efforts to relieve pain, but this need decreases by the time you go home.

Ways to relieve pain after surgery include medicines taken by mouth, shots given into a muscle, shots given into a vein (intravenous) and the use of local anesthetics that act directly on nerves to numb the pain. When it's time to go home, pain pills taken by mouth should be enough to relieve your pain.

Intravenous pain relievers are often given continuously with a pump while you are in the hospital. And, you can give yourself more medicine by pressing a button. This is known as patient-controlled analgesia (PCA). It keeps you from being in pain while waiting for medicine.

Local anesthetics can be injected directly into the surgical wound, onto the nerve that provides sensation to the area being operated on. They can also be given through an epidural catheter (a thin tube).

In spinal anesthesia, a thin needle or tube is put through your back into the spinal fluid so that medicine can act directly on the nerves in the spinal cord.

Epidural catheters are inserted through your back into a space outside of the spinal cord (the epidural space). Often, an epidural catheter will be placed before the operation and left in place for several days. Medication is given continuously through the epidural catheter with a pump and you can give yourself more medication by pressing a button. This method of pain relief is called patient-controlled epidural analgesia (PCEA).

Often, pain relief methods using local anesthetics are combined with general anesthesia so you wake up from surgery with pain control already working.

What is preemptive analgesia?

As doctors learn more about why you have pain, it's becoming clear that the timing of pain medicine can be very important. Pain sensitizes the nervous system so the pain that follows is worse. This serves a useful purpose. Without doctors to fix broken bones and other injuries, the only way to heal is to not use an injured body part. Pain keeps the injured body part from being used so it can heal. Greater sensitivity to pain is not always useful when doctors can use casts and other devices to fix bones in place, and sutures to repair injuries and close surgical incisions.

We now know that your body is responding and becoming more sensitized to pain during surgery, even though you can't feel anything under general anesthesia. This is one reason why there is a growing trend to give general anesthesia with some type of local anesthesia to numb the area of the surgical incision before the surgeon makes an incision. This approach to pain relief is called preemptive analgesia. This approach is fairly new and is still being developed. Some experts believe that this type of pain relief can improve recovery and decrease pain even after you have left the hospital.

What should I do to make sure I receive the best possible pain relief?

First, talk with your surgeon and anesthesiologist before the operation to learn what will happen on the day of surgery and the first days after the operation. Next, know that although some pain is likely, you should not be in a lot of pain. Be ready to talk honestly with the nurses and physicians about how you feel. When getting ready for surgery, you should ask both the surgeon and the anesthesiologist about the plan for pain relief. Using some type of local anesthetic with PCA can make you feel more comfortable. Planning for pain relief before surgery and telling your doctors and nurses how you feel after the operation will help you get the best possible pain relief after surgery.

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