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Pain Relief After Surgery

1. What are the choices for pain relief after surgery? There are several choices for pain relief after surgery:

Intravenous "I.V." or Intramuscular "I.M." Medications: Pain-relieving medications that are injected into a vein or muscle will help to dull your pain but may not eliminate it completely. These medications are usually prescribed by your surgeon.

Local Anesthesia: Other pain-relieving medications may be injected into the surgical incision by your surgeon. These medications are local anesthetics. They provide numbness or loss of sensation in a small area.

Regional Blocks: Regional blocks can reduce the pain after surgery and can provide either analgesia or anesthesia. Local anesthetics and other drugs are used for these procedures to reduce or "block" pain and other sensation over a wider region of the body.

2. It is possible to combine regional and general anesthesia and in what situations would this combination be desirable?
Often, both general anesthesia and regional anesthesia are combined during the procedure, especially if the one of the intentions of the regional technique is to help control pain after surgery. If you have regional anesthesia in addition to general anesthesia, this may possibly allows your anesthesiologist to use less general anesthesia which might allow you to recovery faster after the surgery is finished. The types of regional anesthesia techniques that are commonly used in combination with general anesthesia are single-shot (one time) injections of nerve blocks and continuous catheters.

If you receive a single-shot nerve block, you can expect up to 4-24 hours of pain relief after surgery; however, the exact duration of analgesia depending on many factors. For adults, single-shot nerve blocks are a one time injection of local anesthesia given typically under sedation but before general anesthesia is started. A single-shot nerve block may also be given to children to help with pain control after surgery but in most cases, your anesthesiologist will perform the block while your child is already asleep (after general anesthesia has started). Single-shot nerve blocks are often used for pain control after orthopedic (bone and joint) surgery.

3. What if I need pain control for more than 24 hours after surgery?
If you require pain control for more than 24 hours after surgery, for many types of surgery then your anesthesiologist can place a continuous catheter to allow the continuous deliver of pain relieving medications. If you receive a continuous catheter, you can generally expect analgesia for as long you have the catheter. Insertion of a continuous catheter for postoperative pain is typically done under sedation but before general anesthesia is started in adults and generally placed after general anesthesia is started in children.

4. What are some of the possible side effects from the medications used for pain relief after surgery?
The two commonly used types of medications are opioids (narcotics) and local anesthetics. In normal doses, narcotics may cause some itching, nausea, retching, or drowsiness. Local anesthetics may cause some numbness or, heaviness. There will be some difficulty with weight-bearing on the blocked leg afterwards, and patients should take care not to fall; however, the pain control lasts longer than the motor effects.

5. Can the regional block used for my surgery also help with pain relief after surgery?
The regional block used for the surgery may last for some time after the end of surgery and may help with pain relief during this time. Occasionally, a catheter may be placed during the nerve block to extend the duration of pain relief after surgery.

6. What will I feel after the block takes effect?
No matter what regional anesthesia technique you receive, whether it be a single-shot or a continuous catheter technique, you might some degree of temporary numbness, heaviness or weakness in your legs at the end of surgery. You might also not have the full muscle control of the affected part of your body. Please be sure to always check with your physician or nurse before you start to use any affected extremities for standing up or try to do other motor tasks. Also make sure that you don't put pressure on any extremity which feels numb from your regional analgesic technique.

7. How long will the block last?
Depending on the type of medication used for the regional block, the block may last for several hours after the conclusion of surgery. This may help with pain relief after surgery. If a catheter was placed during the nerve block, then the duration of analgesia can be extended for as long as you need it. After the catheter is placed, medication can be administered through it as necessary. After the catheter is removed, sensations will return to normal typically within a few hours.

8. Can I keep my regional block catheter when I go home after surgery?
Depending on your anesthesiologist, surgeon and hospital, continuous peripheral nerve catheters have been used for analgesia at home after surgery. These outpatient or ambulatory catheters need some special attention and preparation and not all hospitals will provide this service. First, your anesthesia provider will check with your insurance company whether they cover the costs of the home going catheter and the nursing visits required for its care. You will then receive formal instructions in the process of catheter care including a list of emergency contact phone numbers. You will also receive a special pump which will be connected to your catheter and deliver the local anesthetic. Depending on the protocol utilized at your healthcare facility, you can change the reservoir of that pump yourself or it will be changed by a visiting nurse.

For most types of orthopedic surgeries, these peripheral catheters may stay in for an average of 3-4 days. You should inspect the catheter entry site for any signs of redness, swelling or purulent discharge. Whenever you notice one of those symptoms, contact your anesthesia provider or the visiting nurse immediately. Visiting nurses will inspect your catheter site with every visit. They will also be able to adjust the flow rate of your pump if needed. If no visiting nurse service is used by your institution, you will receive the appropriate instructions for managing the pump and removal of the catheter. Always make sure the catheter is completely removed. The most common reason for peripheral nerve catheter failure to provide adequate pain control is dislocation of the catheter. In order to lessen the chances of this happening, you might want avoid any pulling or tension on the infusion line and catheter.

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