Your anaesthetist will play a very important role in pain control following surgery.
Pain relief is paramount. Adequate pain control will help prevent certain post operative complications such as chest infections, heart attacks and blood clots. It is important that you are able to get up and about quickly and perform certain tasks such as breathing exercises and coughing. Doing these simple things will help you to recover and get home sooner.
There are many ways that pain can be controlled. Your anaesthetist will discuss the options with you before your operation.
1. Simple Painkillers (Tablets)
Often patients will be prescribed a combination of tablets to control pain. Using two or more different medications which work in different ways can result in better control of your pain than using only one type of medication alone. Commonly used medications include paracetamol, anti-inflammatory drugs (eg. ibuprofen, diclofenac), tramadol, codeine and oxycodone.
Side effects of anti-inflammatory medications include stomach irritation, worsening of asthma (although most asthmatics tolerate these medications well) and worsening of kidney problems. Medications such as oxycodone and codeine can cause drowsiness, itching and constipation.
2. Morphine and Fentanyl (including PCAs)
Morphine and Fentanyl are opioid medications. They are strong painkillers which are very effective but have a number of side effects. These side effects include drowsiness, confusion, itching, nausea, breathing problems and constipation. For this reason, patients receiving these medications are regularly monitored during their hospital stay.
Most commonly these medications are given by a technique known as Patient Controlled Analgesia or PCA. What this means is that there is a pump attached to your intravenous drip and the pump is controlled by a button which the patient controls. Every time the button is pressed, a small amount of painkiller is delivered. The pump has a “lock out” time (usually 5 minutes) so the button will only work every 5 minutes. The medications tend to make you sleepy, so if you have more than you need, you are likely to fall asleep and not press the button. DO NOT ALLOW ANYONE TO PRESS THE BUTTON FOR YOU.
3. Epidural Anaesthetic
Sometimes, depending on the operation, people are offered epidural pain relief. Epidurals involve inserting a very fine tube (catheter) through a needle into your back into a space called the epidural space. The needle is then taken away and the catheter left behind. Painkilling medications can then be injected through the catheter and the catheter can be left in place for a number of days.
The medication numbs the nerves that supply the area of the operation and make you feel more comfortable and can have a significant impact on your recovery. However, there are a number of side effects that are important to know about.
- Low blood pressure, usually treated with intravenous fluids.
- Weakness of the legs. However you should still be able to mobilise.
- Severe headache can occur with a risk of approximately 1 in 200
- Damage to nerves and potential of paralysis is very, very rare but has been described.
4. Nerve Blocks
Anaesthetists can block nerves for certain operations, especially operations on arms, shoulders, knees, hips and feet.
Nerve blocks offer very good pain relief. It is important to realise the affected limb will be completely numb and weak for a period of time (usually 12-24 hours) after the operation.
There is a small risk that the needle, infection or a blood clot can cause damage to the nerve. Again the risk is very rare but well described. Permanent nerve damage can occur in these circumstances.