Other than for short procedures under Local Anaesthesia most patients will need some form of pain relief after surgery.
We know that pain after an operation varies hugely between patients, obviously depending on what operation they have had but also because we are unique individuals with our own expectations, our own pain thresholds, our own personal way of dealing with something unpleasant and also with our own way of communicating with others whether they are family, friends or health care workers.
All of these are important when it comes to dealing with pain after surgery.
We know, too, that patients who are very anxious can have more pain, so it is especially important that if you have any worries or concerns about your surgery beforehand or afterwards you should tell the staff looking after you - they are likely to be able to offer reassurance .
What to expect
It is normal to have some pain after most types of surgery, but anything more than mild pain causes us to suffer and can significantly slow down recovery. Severe pain can increase the risk of complications like chest infection after abdominal surgery or venous thrombosis due to immobility.
One of the basic roles of the anaesthetist and our Acute Pain Service (‘APS’) is to provide our patients with good postoperative pain relief wherever possible.
In general more major surgery can potentially be followed by pain that is more severe and of longer duration, however there is no ‘right’ level of pain for any particular operation. We try to prevent severe pain following any operation and if it occurs afterwards we aim to treat it quickly.
Following major surgery if a specialised technique has been used to give you pain relief (eg Patient Controlled Analgesia, Epidural, Nerve Block Catheter) you will be reviewed by the Acute Pain Service - expert doctors and nurses - who will assess the effectiveness of your pain relief and make recommendations for ongoing care. The APS also provides backup to our ward nurses and doctors should any other patient develop severe or difficult to treat pain after surgery.
We use many different strategies to prevent or treat pain for different types of surgery. Here are some examples:
Oral (‘by mouth’) painkillers
There are several types of pills, tablets or liquids that are given regularly or sometimes when needed after surgery. These range from simple Paracetamol to anti-inflammatory medications (eg Arcoxia) and strong Opioid (related to morphine) medications.
We often prefer to give oral medication if patients are able to take this, and particularly with milder painkillers we prefer to give them regularly, sometimes in combination with stronger ‘as needed’ medicines.
Sometimes we find that patients who are feeling only mild or moderate pain decline their simple painkillers only to need ‘rescued’ with stronger medications later. As a general rule if you have pain after your surgery and you are offered a regularly prescribed painkiller, even simple Paracetamol, we would advise taking this - your overall pain control will be better!
Intravenous (‘IV’) or Intramuscular (‘IM’) pain relief is normally reserved for those who initially cannot take oral medication after their operation. Most patients are given IV pain relief as part of a General Anaesthetic and some of these drugs will continue to work afterwards.
For some major surgery we use a special type of IV pain relief called Patient Controlled Analgesia (‘PCA’). This uses a programmed pump which you, the patient, uses via a handset to give yourself small IV ‘top-up’ doses of a strong painkiller (eg morphine, fentanyl). PCA is popular because it gives you control and we know from research that it gives better pain relief (and patient satisfaction) after major surgery than some alternatives
PCA pumps are designed to avoid any risk of overdosage and it is important to stress that there is no danger of addiction when we use self-administered IV pain relief for pain after surgery. PCA is popular because it gives you control and we know from research that it gives better pain relief after major surgery than some alternatives.
Local Anaesthetic Techniques
There are a very wide variety of methods to provide pain relief after surgery which use local anaesthetics - drugs which cause numbness by blocking nerve signals. Some of these techniques are also used to provide anaesthesia during the operation, for example spinals or nerve blocks. Others use local anaesthetic injections or catheters inserted during or at the end of surgery, for example injection at the end of knee replacement surgery or wound catheters following open abdominal surgery.
Local anaesthetic techniques are popular because they can help us avoid the side effects of strong painkillers taken orally or by injection. Often they give the best possible pain relief.
Although local anaesthetic techniques are not suitable or available for all patients and all types of surgery we will discuss them with you if appropriate and if possible offer them to you. If you are interested in finding out more about what might be available for your surgery do please ask your surgeon or anaesthetist!
A final word about pain after surgery. Some patients expect to have severe pain after an operation and ‘deal with it’ themselves without asking for help or medication. However, pain can sometimes be a sign of complications or that something is not right, so we would very much prefer you to tell us if you do have significant pain so that we can assess you and help you.
Contributed by Department of Anaesthesia