To help you have the best recovery possible, it is important that your pain is adequately controlled through the period after surgery. A multimodal pain control regimen (using several different methods to control your pain) has been shown to more effectively control pain and minimize the side effects of any single pain control method. There are several ways that you can control your pain without medication. Even if you do require medication, combining medication with these techniques can reduce the medication you require.
Many of these techniques work by reducing and controlling swelling in the time immediately after your surgery. Swelling, at its most basic description, is fluid trapped in and around the surgical site, like a sponge that is soaking wet. This swelling acts like a bruise, causing the area to be tender and painful. If your dressings become tight due to swelling, this can also cause pain. Luckily, there are several techniques that can help swelling to resolve and keep it from happening again:
-Rest and Protect the surgical site:
This avoids additional injuries (and new swelling) in the surgical area.
-Elevation above your heart:
This allows gravity to help drain the swelling fluid out of the affected area.
-Ice (20 minutes on, 20 minutes off):
This decreases the amount of fluid entering the area, so less can become trapped and contribute to swelling. Ice and Icepacks applied directly to the skin can cause skin injuries. It is safest to have a towel or cloth between the ice and skin.
-Gentle Compression:
This squeezes fluid out of the affected area, helping it reenter your circulation. (Imagine wringing out the wet sponge.) Your postop dressing will be applied so that it is lightly compressive. Contact Dr. Fuller if you have questions about adding more compression. Too much compression can prevent good circulation, so if your compression feels too tight, it probably is!
-Gentle Range of Motion:
The muscles around the surgical site act like small pumps, helping fluid to leave the affected area. This also helps to preserve your range of motion and prevent stiffness. Your therapist can help you set goals for range of motion exercises.
If you have a splint in place, there are parts of your surgical site that Dr. Fuller does not want you to move until they are healed; do not move an area if you aren’t sure that it is safe. Do not hesitate to ask if you have any questions about this!
There are also several medications that can contribute to pain control. Using a combination of these is more effective that using one on its own. Options include:
-Local Anesthesia (Lidocaine, Bupivacaine):
These are liquid medications that Dr. Fuller can inject around your incision and surgical site. These work by “turning off” nerves in the affected areas, keeping them from sending pain signals to your brain. Anesthesiologists can also place these medications around larger nerves farther up your arm, serving the same purpose (this is called a block). These techniques help control pain for the first few hours to days after your surgery. These medications are used immediately before, during, or after your surgery while you are still in the hospital or surgery center.
If you decide to have a block performed, you should discuss the risks, benefits and alternatives with your anesthesia provider. If you are having surgery close to a nerve, Dr. Fuller may want to check the nerve’s function after surgery. In this case, a block should be avoided. Ask Dr. Fuller if you have any questions about this!
If you have a block performed, it is a good idea to continue to take your pain medication as prescribed until the block wears off. This can protect you from having sudden, severe pain when the block wears off and your nerves wake up!
-Tylenol/Acetaminophen:
This is a common over-the-counter pain medication that works through several mechanisms in your brain, spinal cord, and at the surgical site to reduce pain. Although it is used for mild pain in most cases, higher doses can be very effective for pain after surgeries. The side effect of greatest concern is toxicity to the liver, which can occur if you take more than 3 grams in a day. Please let Dr. Fuller know if you have underlying liver disease.
-NSAIDs (Ibuprofen, Naproxen, Ketorolac, Indomethacin, and Celecoxib):
These are common over-the-counter pain medications that work by decreasing the amount of swelling that occurs around the surgical site. Although they are used for mild pain in most cases, higher doses can be very effective for pain after surgeries. Typically, Dr. Fuller prescribes high-dose Ibuprofen for the immediate postop period. Other options are also available. These medications can have side effects on your stomach and kidneys, so please let Dr. Fuller know if you have any medical problems affecting these areas. You can protect your stomach by taking the medication with food, and you can protect your kidneys by staying well hydrated.
-Gabapentin:
This is a medication that controls pain by affecting your nerve function. It can be effective for many types of pain, especially for surgeries around nerves. The most common side effect is drowsiness, which can cause injuries if it comes on suddenly. To see how your body reacts, Dr. Fuller recommends slowly increasing your dose during the first few days of use. For example, if you are instructed to take Gabapentin 3 times daily, you can take one pill the first day, before you go to bed. You can take 2 pills on day 2, and 3 pills on day 3 (and all days after). If you notice problematic drowsiness, you should not increase your dose.
-Narcotics (oxycodone, codeine, morphine, fentanyl):
These are strong medications that are sometimes required after surgeries for severe pain. They are very effective, but can have many side effects including constipation, urinary retention, slowed heart rate, and slowed breathing rate. Overdoses can make you lose consciousness, and can be fatal. Narcotics should be reserved as a last resort, after trying the other medications and techniques listed above. Even if you require the use of a narcotic, using a multimodal regimen can decrease the amount of narcotic you require, and help you avoid these side effects.