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Avera McKennan Hospital & University Health Center

1325 S Cliff Avenue
P.O. Box 5045
Sioux Falls, SD 57117-5045
605-322-8000

Pain Control After Surgery

Pain Control After Surgery

Pain control following surgery is a major priority of the medical staff at Avera McKennan Hospital & University Health Center. While you should expect to have some pain after surgery, our team will make every effort to safely minimize your discomfort.

The following information will help you understand your pain management options, describe how you can help your providers control your pain, and enable you to take an active role in pain treatment.

Upon admission, the surgeon, anesthesiologist and nursing staff will review your medical history including all medications (prescription and over-the-counter), vitamins and herbal supplements, and anything else you are taking. This may affect the choice of medications for your pain control.

Click on the "view animations" tab below to watch narrated animation overviews of pain management, anesthesia and physical therapy.

Overview

Why is pain control so important?

In addition to a more pleasant experience, better pain control can help speed recovery and may reduce your risk of complications after surgery, such as pneumonia and blood clots. If your pain is well controlled, you will be able to walk, complete physical therapy and perform deep-breathing exercises more effectively.

What kinds of pain will I have after surgery?

You may be surprised where you experience pain after surgery. Quite often, the incision is not the only area of discomfort. You may or may not feel the following:

  • Muscle pain - Pain in the neck, shoulders, back, hips, arms, legs or chest from lying on the operating table, or prolonged bed rest.
  • Throat pain - Your throat may feel sore or scratchy with some hoarseness if a breathing tube was used in the operating room.
  • Movement pain - Sitting up, walking, and coughing are all very important recovery steps after surgery, but they may cause increased pain at or around the surgical site. Your doctors, nurses and therapists will set safe limits on your activity.

What can I do to help keep my pain under control?

Good communication is the most important aspect of pain management. Please tell your nurse when you are having pain. Patients should never feel as though they are being a "bother." When pain increases, this may signal a need for more medication, or a different option altogether.

You will be frequently asked by the medical staff to rate your pain. This is done on a scale of 0-10. Our scale sets "0" as no pain and "10" the worst pain you can imagine.

Reporting your pain as a number helps the doctors and nurses judge how well your treatment is working and whether to make any changes. Patients quite often have a hard time converting their pain to a number, especially in the upper range.

We tell patients at a level of "7" it becomes difficult to focus on activities other than your pain, such as watching TV or working on a computer. Our table below gives facial expressions of what various numbers may look like. The number you choose is very important, however, and our ultimate goal is to put you in the best condition to walk, cough, deep breathe and safely recover from surgery.

Who is going to help manage my pain?

Based on the type of surgery and a review of your medical history, the surgeon will have a pain management plan. Before surgery, an anesthesiologist will review your medical history, perform an exam, and then discuss your anesthetic options. This will include pain management during and after surgery.

The anesthesiologist may choose to consult the Acute Pain Service (APS) to help manage your pain following surgery. Doctors and pharmacists with this service are specially trained in the types of pain control options described on the next several pages. Remember, you are the one who ultimately decides which pain control option is chosen.

After surgery, you will be continually assessed to ensure your comfort. If necessary, new options and adjustments to your pain management regimen will be made.

Pain control options

Depending on the type of surgery and your medical history, you may receive more than one type of pain treatment. All of these options are considered safe, but like any therapy, they are not free of risk. Both side effects and complications are possible, however, they occur very rarely.

Intravenous patient-controlled analgesia (PCA)

Patient-Controlled Analgesia (PCA) is a computerized pump that safely permits you to push a button and deliver small amounts of pain medicine into your intravenous (IV) line. No new needles are injected into your skin or muscle for this. PCA provides stable pain relief in most situations. Many patients like the sense of control they have over their pain management without having to ask a nurse for each dose.

The PCA pump is programmed to give a certain amount of medication when you press the button. It will only allow you to have so much medication, no matter how often you press the button, so there is little worry that you will give yourself too much. The amount of medicine can be adjusted at any time based on your response.

We caution patients against a family member pushing the PCA button. Sedation is a side effect of the pain medications and may signal reaching the maximum safe dosage. Additional doses at this point may be dangerous.

Epidural analgesia

Many people are familiar with epidural analgesia. It is commonly used to control pain during childbirth. Postoperative epidural analgesia uses a pump to continuously deliver pain medicine into the spine through a very thin catheter taped to your back. During labor, epidural analgesia will help block the pain of incisions anywhere below the neck.

Placing the epidural catheter usually causes no more discomfort than having an IV inserted. Before placement, a sedating medication may be given through your IV to help you relax. The skin of your back is cleaned with a sterile solution and numbed with a local anesthetic.

Next, a thin needle will be carefully inserted between the vertebrae into an area called the "epidural space." The catheter is then passed through the needle into the epidural space, and the needle is then removed. During and after your surgery, pain medications can be infused through this epidural catheter with the goal of providing you excellent pain control when you awaken. If additional pain medication is required, we can increase the dosage of the epidural or supplement with IV medications.

We feel epidural analgesia is more effective in relieving surgical pain than intravenous medication. There is less sedation and the numbing effect on nerves provides greater ability to cough, deep breathe and walk. For postoperative patients, epidural analgesia may reduce the risk of serious complications such as blood clots and pneumonia.

Patients who may not be a candidate for epidural placement include:

  • Those with an infection in their blood or on their back
  • Those with very low blood pressure
  • Patients who have thinned blood
  • Patients with a history of major back surgery

Epidural analgesia is safe, but like any procedure or therapy, it is not risk free. Sometimes the epidural does not adequately control pain. In this situation, you will be given additional treatments or be offered a replacement of the epidural. Nausea, vomiting, itching, and drowsiness can occur. Occasionally, numbness and tingling or weakness of the legs can occur but this disappears after the medication is reduced or stopped. Headaches can occur, but this is rare. Severe complications, such as nerve damage and infection, are extremely rare.

Nerve block

You may be offered a nerve block to supplement your pain control after surgery. Whereas an epidural controls pain over a broad area of your body by blocking multiple nerves in the spine, a single nerve block is used to treat a smaller region of your body, such as an arm or leg. Usually a catheter is placed near the nerve and connected to a pump for uninterrupted delivery of pain medicine.

There are several potential advantages of a nerve block. Its main goal is to provide a significant reduction in the amount of narcotic medication used after surgery while increasing overall mobility. This may result in fewer side effects, such as nausea, vomiting, itching, and drowsiness. All injection therapy has risk involved. Our anesthesiologists use ultrasound-visual guidance when placing postoperative nerve blocks and catheters. We feel this increases the success of the block while minimizing traumatic complications.

You, your anesthesiologist, and surgeon will decide before surgery if a nerve block is a suitable pain management option for you.

Pain medications taken by mouth

At some point during your recovery from surgery, your doctor will order pain medications to be taken by mouth (oral pain medications). These may be ordered to come at a specified time, or you may need to ask your nurse to bring them to you. Make sure you know if you need to ask for the medication! Most oral pain medications can be taken every four hours.

Important! Do not wait until your pain is severe before you ask for pain medications. Also, if the pain medication has not significantly helped within 30 minutes, notify your nurse. Extra pain medication is available for you to take. You do not have to wait four hours to receive more medication. Most patients will have a backup IV medication ordered when oral medicines are ineffective.

Risks and benefits associated with pain medication

Narcotics IV: Medications such as morphine, fentanyl, hydromorphone

  • Benefits: Strong pain relievers. Many options are available if one is causing significant side effects. 
  • Risks: May cause nausea, vomiting, itching, drowsiness, and/or constipation. The risk of becoming addicted is extremely rare.

Narcotics by mouth: (Percocet®, Vicodin®, Darvocet®, Tylenol ®)

  • Benefits: Effective for moderate to severe pain. Many options available.
  • Risks: Nausea, vomiting, itching, drowsiness, and/or constipation. Stomach upset can be lessened if the drug is taken with food. You should not drive or operate machinery while taking these medications.

These medications often contain acetaminophen (Tylenol®). Make sure other medications you are taking do not contain acetaminophen. For adults, a daily acetaminophen dose over 3250 mg can be damaging to the liver. Always ask your medical provider or pharmacist if you have any questions or concerns. Please confirm all medication dosages for pediatric patients.

Non-narcotic Analgesics (Tylenol®, Feverall®)

  • Benefits: Effective for mild to moderate pain. They have very few side effects and are safe for most patients. They often decrease the requirement for stronger medications, which may reduce the incidence of side effects. 
  • Risks: Liver damage may result if more than the recommended daily dosage is used. Patients with pre-existing liver disease or those who drink significant quantities of alcohol may be at increased risk.

Nonsteroidal Anti-inflammatory Drugs (NSAIDS): ibuprofen (Advil®), naproxen sodium (Aleve®), celecoxib (Celebrex®)

  • Benefits:These drugs reduce swelling and inflammation and relieve mild to moderate pain. Ibuprofen and naproxen sodium are available without a prescription, but you should ask your doctor about taking them. They may reduce the amount of opioid analgesic you need, possibly reducing side effects such as nausea, vomiting, and drowsiness. If taken alone, there are no restrictions on driving or operating machinery.
  • Risks: The most common side effects of Nonsteroidal Anti-inflammatory medication (NSAIDS) are stomach upset and dizziness. You should not take these drugs without your doctor's approval if you have kidney problems, a history of stomach ulcers, heart failure or are on "blood thinner" medications such as Coumadin® (warfarin), Lovenox® injections, or Plavix®.

Ways to relieve pain without medication

There are other non-medication options to relieve pain, and it is important to keep an open mind about these techniques. When used along with, or instead of medication, these techniques can dramatically reduce pain.

Relaxation tapes or guided imagery is a proven form of focused relaxation that coaches you in creating calm, peaceful images in your mind; a "mental escape." For the best results, practice using the tape or CD before your surgery, and then use it twice daily during your recovery. You can get relaxation tapes at a bookstore, or rent CDs from your library. You can bring a battery-operated listening device to the hospital to play prior to surgery and during your hospital stay.

Listening to soft music, watching television, playing video games, or reading may divert your attention from pain.

At home, heat or cold therapy may be an option that your surgeon will choose to help reduce swelling and control your pain. Specific instructions for the use of these therapies will be discussed with you by your surgical team.

If you have an abdominal or chest incision, you will want to splint the area with a pillow or blanket when you are coughing or breathing deeply to decrease motion near your incision.

Always make sure you are comfortable with your treatment plan. Talk to your doctor and nurses about your questions and concerns. This will help avoid miscommunication, stress, anxiety, and disappointment, which may make pain worse. Keep asking questions until you have satisfactory answers. You are the one who will benefit.

Controlling pain at home

You may be given prescriptions for pain medication to take at home. These may or may not be the same pain medications you took in the hospital. Talk with your doctor about which pain medications will be prescribed at discharge. 

IMPORTANT Note: Make sure your doctor knows about pain medications that have been successful or caused you problems in the past. This will prevent possible delays in your discharge from the hospital.

Discharge

Your doctors may have already given your prescription for pain medication prior to your surgery date. If this is the case, it is best to be prepared and have your medication filled and ready when you return home from the hospital. Plan to have your pain pills with you on your ride home if you are traveling a long distance. Check with your insurance company regarding your prescription plan and coverage for your medication. Occasionally, a pain medication prescribed by your doctor is not covered by your insurance company.

If you do not receive your prescription for pain medication until after the surgery, make sure a family member takes your prescription and either gets it filled at one of the Avera McKennan pharmacies on campus or soon after your discharge from the hospital. Have a plan for filling prescriptions before leaving the hospital.

Other considerations:

  • Make sure you wear comfortable clothes, and keep your coughing and deep-breathing pillow or blanket with you.
  • You may want to have your relaxation music available for your travels.
  • If you are traveling by plane, make sure you have your pain pills in your carry-on luggage in case the airline misplaces your checked luggage.

While at Home

  • Remember to take your pain medication before activity and at bedtime. Your doctor may advise you to take your pain medication at regular intervals (such as every four to six hours).
  • Be sure to get enough rest. If you are having trouble sleeping, talk to your doctor.
  • Use pillows to support you when you sleep and when you do your coughing and deep-breathing exercises.
  • Try using the alternative methods mentioned earlier. Heating pads or cold therapy, guided imagery tapes, listening to soft music, changing your position in bed, and massage can help relieve your pain. 

IMPORTANT NOTE: If you need to have stitches or staples removed and you are still taking pain medications, be sure to have a friend or family member drive you to your clinic appointment. You should not drive or operate equipment if you are taking narcotic-containing pain medications. Check the label of your prescription for any warnings or ask your doctor, nurse, or pharmacist.

FAQ's

I am nervous about getting "hooked" on pain pills. How do I avoid this?

The risk of becoming addicted to pain medication after surgery is very small. The bigger risk is a possible prolonged recovery if you avoid your pain medications, and cannot effectively do your required activities. If you are concerned about addiction, or have a history of substance abuse, talk with your doctors. They will monitor you closely during your recovery. If issues arise following surgery, they will consult the appropriate specialists.

I am a small person who is easily affected by medicine. I am nervous that a "normal" dose of pain medication will be too much for me. What should I do?

During recovery, your health care team will observe how you respond to pain medication and make changes as needed. Be sure to communicate with your doctors about any concerns you have prior to surgery. The relatively small doses of pain medication given after surgery are highly unlikely to have an exaggerated effect based on your body size.

I don't have a high tolerance for pain. I am afraid that the pain will be too much for me to handle. What can I do?

Concern about pain from surgery is very normal. The most important thing you can do is to talk with your surgeon and anesthesiologist about your particular situation. Setting pain control goals with your doctors before surgery will help them better tailor your pain treatment plan. Treating pain early is easier than treating it after it has set in. If you have had prior experiences with surgery and pain control, let your doctor know what worked or what did not work. Remember, there are usually many options available to you for pain control after surgery.

I normally take Tylenol® if I get a headache. Can I still take Tylenol® for a headache if I am on other pain medication?

As discussed earlier, before taking any other medication, be sure to talk to your doctor. Some of the medications prescribed for use at home contain acetaminophen (Tylenol®) and if too much is taken, you may become ill. In order to avoid getting too much of any medication, discuss this issue with your doctor or pharmacist before you leave the hospital.

Your Role

Ask your doctors and nurses about:

  • Pain and pain control treatments and what you can expect from them. You have a right to the best level of pain relief that can be safely provided.
  • Your schedule for pain medication in the hospital.
  • How you can actively participate in a pain-control plan.

Inform your doctors and nurses about:

  • Any surgical pain you have had in the past.
  • How you relieved your pain before you came to the hospital.
  • Pain you have had recently or currently.
  • Pain medications you have taken in the past that work well as well as those that do not.
  • Pain medications you have been taking prior to surgery.
  • Any pain that is not controlled with your current pain medications.

You should:

  • Help the doctors and nurses "measure" your pain and expect staff to ask about pain relief often and to respond quickly when you do report pain.
  • Ask for pain medicines as soon as pain begins.
  • Tell us how well your pain is relieved and explain your pain relief expectations.
  • Use other comfort measures for pain control such as listening to relaxation or soft music, repositioning in bed, etc.

Your doctors at Avera McKennan are committed to providing you with the safest and the most effective pain management strategy that is most acceptable to you.

View Animations

View the three animations below to learn more about pain control, anesthesia during surgery and physical therapy.

About Pain Management

About Anesthesia

About Physical Therapy