<< Back to Patient Information List

There are many approaches to dealing with post operative pain. The approach which is most appropriate depends on the patient and the type of operation which you are having. We encourage all patients to discuss this with their anaesthetist at the pre-op visit. The following is a guideline to give you some idea what to expect following your procedure.

MINOR PROCEDURES
(Severe pain not expected to last beyond 4-6 hours)
Many procedures fall into this category and are often performed as a day only procedure. Examples include:

• Closed reductions of simple fractures
• Gynaecological surgery eg Dilatation and Curettage, minor laparascopic procedures including sterilization procedures
• Adenoidectomy and Grommets
• Excision of minor skin lesions
• Breast lumpectomies

Patients having these types of procedures require intra-operative narcotics and are often given further loading doses of narcotic in recovery. Common parenteral narcotics include morphine, pethidine and fentanyl. Local anaesthetic agents are used wherever possible. It is expected that pain control can be maintained with oral medications following discharge from recovery. Common oral agents include Panadeine Forte, Tramadol, Digesic. Occasionally patients may require further intramuscular injections of narcotic in the Day only ward. Anti-emetic such as Zofran, Novaban, Maxalon and Stemetil are used whenever possible.

MAJOR PROCEDURES

(Oral Pain medications are unlikely to control pain)
Patients having major surgical procedures. Examples include:

• Open reductions of more complicated fractures
• Major joint replacement or reconstructions
• Upper abdominal laparoscopic procedures including laparoscopic cholecystectomy
• Lower intestinal laparoscopic procedures including laparoscopic appendectomy
• All open abdominal procedures
• Tonsillectomy
• Mastectomy

Patients having the above surgical procedures often require repeat injections of narcotic type drugs. The Patient Controlled Anaesthetic Machine (PCA) has greatly improved delivery of pain controlling medications to patients. This is the most common approach to post-operative pain management. You will be given a push-button which delivers a small quantity of narcotic (morphine, pethidine ,fentanyl) with each press. A lockout (usually 5 minutes) is programmed into the device by the anaesthetist which prevents against overdoses. No one other than yourself is permitted to push the button.

If the button is pushed within the lockout period no further dose is delivered. You must push the button and wait for the effect and push the button again if pain persists. You will be given the PCA machine in recovery after the operation. Recovery staff are permitted to give loading doses to get you started. With the PCA machine you are in the “driver’s seat” in control of your pain medication. Nursing staff on the wards will check your pulse, blood pressure, level of consciousness and respiration whilst you have the PCA machine. The device will be ceased when you pain can be controlled with oral medications.

EPIDURALS

This is being used more frequently for post operative pain control. Patients having chest and abdominal procedures can achieve superior pain control using this technique. Epidurals are also used successfully in patients having hip or knee replacements. The are advantages and disadvantages associated with this technique and we encourage you to discuss this with your anaesthetist at the time of the pre-op visit.


<< Back to Patient Information List