Pain control: how to stay on top of it after surgery
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The Question: Before I undergo a knee replacement, I have to see an anesthesiologist. I know the visit is to go over details to put me under during the operation but I am also very worried about how to control my pain both in hospital after being sent home. How and when do I bring this up?
The Answer: You have two issues with regard to pain: one immediately after surgery while in hospital and another when you go home. While most surgeons write a prescription for pain medication after surgery, I would advise you to use your appointment with your anesthesiologist to see what can also be done about pain control after you leave hospital. Oftentimes, patients are sent home with a one-size-fits-all pain plan that may work for most but certainly not all. Ideally, you want something more personalized.
“Patients list pain control after surgery as one of their major concerns” said Dr. Colin McCartney, staff anesthesiologist and director of anesthesia research at Sunnybrook Health Sciences Centre. “And some patients are very reluctant to take medications after discharge and would rather suffer pain and limitation of activity instead.”
Severe postoperative pain can cause an increase in blood pressure and heart rate and it may decrease ability to breath deeply and cough leading to greater risk of cardiac problems and chest infection after surgery. And because poor pain control inhibits movement, those with limited mobility are predisposed to other risks such as blood clots, according to Dr. McCartney, who is also a pain specialist.
“There is evidence that those patients who suffer severe pain immediately after surgery are at greater risk of suffering chronic pain months or years afterward,” he said.
While pain and arthritic changes in your knee likely brought you to hospital to undergo a replacement, about 30 per cent of patients who have that type of operation will still be in chronic pain one year after surgery.
You also mentioned you would be put under for a total knee replacement.
There are typically two choices of anesthetic for a knee replacement. A general puts you in a deep sleep. A regional numbs a specific area of your body without affecting your breathing or brain and is often combined with sedation.
Generally speaking, the preferred option at my hospital is to use a regional for knee replacement, largely due to the benefits of better pain control and fewer side effects such as nausea and vomiting after surgery, according to Dr. McCartney.
However, the type of anesthetic – regional versus local – can change depending on where you live or what hospital you are admitted to. Since there are significant variations by city and hospital, ask your surgeon or anesthesiologist if you can choose.
In answer to your question, when you visit your anesthesiologist before knee surgery, ask not only about the type of anesthetic during the operation but also about pain control methods both in hospital after surgery and for when you go home as it is vital to your recovery.
Typically, patients require stronger pain medications in hospital. Some patients are sent home with combinations of anti-inflammatory medication such as ibuprofen with another medication that contains an opioid pain reliever such as codeine + acetaminophen or oxycodone + acetaminophen.
As well, most hospitals have an acute pain team that can give advice on pain control.
Visit the Canadian Orthopaedic Foundation website, where you can virtually connect with other patients who have gone through the same operation.
Lisa Priest is Sunnybrook’s Manager of Community Engagement & Patient Navigation. Her blog Personal Health Navigator provides advice and answers questions from patients and their families, relying heavily on medical and health experts. Her blog is reprinted on healthydebate.ca with the kind permission of Sunnybrook Health Sciences Centre. Send questions to AskLisa@sunnybrook.ca.