POSTOPERATIVE PAIN RELIEF
(The shorter version for Day Surgery Patients)
It is important to read this information carefully before seeing your anaesthetist. The purpose of this webpage is to help you to understand your postoperative pain relief and to assist you in making informed decisions about your care. It contains a lot of information and you may need to read it more than once. Unfortunately, this amount of information is necessary to have you well informed. If you would like to, it is a good idea to discuss this information with a member of your family or a friend. The information provided is of a general nature and is not comprehensive. It does not take your individual circumstances into account. It cannot replace specific advice given to you by your own anaesthetist. If you have any questions or concerns, or there is anything don't understand, talk to your anaesthetist.
People vary enormously in their perception of and response to pain. Only you can feel your pain and only you can decide whether you need assistance to manage it. Following many Day Surgical procedures no ongoing pain relief is required. For example, you would not expect to need pain relief after gastroscopy, colonoscopy and small procedures on the skin. However, after other Day Surgery procedures pain relief may be required and this is usually taken in the form of oral medication at home.
Your anaesthetist will usually give you the first dose of pain relief before or during the operation to make you comfortable when you first wake up. Following surgery it is common for the area of the operation to be numb, rather than sore. This is because it is common for your surgeon or anaesthetist to use local anaesthetic at the operation site during the operation to reduce postoperative pain. This initial pain relief may keep you comfortable for some hours, but once it starts to wear off, you may need to add oral medication.
It is common for the oral pain relief to start with paracetamol ( Panadol ) or paracetamol combined with a small dose of codeine ( Panadeine ). If more pain relief is required it is common to add ibuprofen ( Nurofen ) to this. For larger procedures, your anaesthetist or surgeon may prescribe stronger medications, such as Oxycodone or paracetamol with higher doses of codeine ( Panadeine Forte ). These stronger medications may make you drowsy.
It is important to understand that any medication may cause an allergic reaction. If you have any known allergies, tell your anaesthetist before your operation, so that medications you are allergic to can be avoided. In particular, the same drug can have a number of different names and you may not recognise them all, but your anaesthetist will. It is possible to be allergic to a medication and not know. If you develop itching, rash, difficulty breathing or swelling around your face, do not take any more medication and contact your doctor.
It is important to understand that all medications have side effects and the risk of complications. Some of these may be serious. The most common side effects are discussed below, but the discussion is not comprehensive. If you require more information, talk to your doctor.
These are the simplest forms of pain relief and are the easiest to manage at home. Oral medications are available as mixtures, tablets or capsules. It is usual to give children mixtures. It is important that you carefully follow the directions you are given for taking oral pain relief at home. The amount or dose of medication that you need to take depends on your age and weight and your doctor will let you know how much you need to take. If you don't understand the directions, ask. Your anaesthetist, surgeon or nurse will be happy to explain.
A number of brand names are mentioned on this webpage. These names have been used as you are more likely to be familiar with the brand names, than with the chemical names of the medications. It does not make any difference which brand you use.
Paracetamol. There are several brands of paracetamol ( Panadol or Panamax are the most commonly recognised names, but they are all the same drug) available over the counter at pharmacies or at supermarkets. Paracetamol works best when taken regularly as directed. This form of pain relief is very safe and effective when taken as directed. It is important not to take more paracetamol than recommended. Taking extra paracetamol will not improve your pain relief and can be bad for you. A healthy adult should not take more than 8 tablets containing paracetamol in 24 hours.
Paracetamol/Codeine. Again there are several brands of paracetamol combined with a small dose of codeine ( Panadeine or Codalgin are the most commonly recognised names). This combination is available over the counter at pharmacies only. This preparation is stronger than paracetamol alone, but also has more side effects. It may make you drowsy and may cause constipation. Do not take more than recommended. Again it will not improve your pain relief and may be bad for you.
The paracetamol/codeine combination is also available with a larger dose of codeine ( Panadeine Forte and Codalgin Forte are the most commonly recognised names). This combination is only available on prescription from pharmacies. It provides better pain relief again, but has even more side effects. It is more likely to make you drowsy and cause constipation and may cause nausea and vomiting. Do not take more than recommended. Again it will not improve your pain relief and may be bad for you. While Panadeine Forte is a good drug for short-term use immediately after an operation, it should not be taken over long periods as it may cause addiction and no longer works effectively for pain relief.
Sometimes you will be told to take Panadol or Panadeine or Panadeine Forte 4 hourly, when you go home, depending on how severe your pain is. It is important that you only take one type of these tablets every 4 hours. Do not take Panadol and Panadeine and Panadeine Forte at the same time. This will not improve your pain relief. This will give you too much paracetamol and may be bad for you.
Oxycodone. (Also known as Endone or Oxycontin. ) These are strong pain relieving drugs that are only available on prescription for short-term use. Usually they are only given to you in hospital. Sometimes you may be sent home with these medications. They are stronger than codeine and are even more likely to cause drowsiness, nausea and vomiting. They may cause constipation and are more addictive than codeine.
Tramadol. Tramadol is a prescription only drug, related to the opioid drugs. It is available both as an oral preparation and for injection. It may cause nausea, vomiting and sweating. It may cause drowsiness. Tramadol can cause fitting and is usually not prescribed for people who suffer from epilepsy. Prolonged use of Tramadol may also lead to addiction.
These drugs are useful, because in addition to providing pain relief, they also reduce swelling around the operation site. This group of drugs is not suitable for everyone and you should check with your doctor. They are not suitable for people with heartburn, stomach ulcers or other stomach problems; asthma; heart problems or kidney problems. Pregnant women should avoid this group of medicines.
Some people may already take one of these drugs regularly, if, for example, they have arthritis. It is important that you only take one of the medications in this group . If you take more than one the side effects add together and can be much more severe.
Ibuprofen. (Commonly known as Nurofen, Brufen, Advil or Herron Blue. Again there are a number of brands, which are the same drug). This is available over the counter at pharmacies or from supermarkets. This medication is taken 4 hourly and is commonly taken with the paracetamol preparations.
There are a large number of anti-inflammatory drugs that are available only on prescription from your pharmacy. These include:
Indomethacin. (Commonly known as Indocid )
Naproxen. (Commonly known as Naprosyn or Naprogesic )
Diclofenac. (Commonly known as Voltaren )
Ketoprofen . (Commonly known as Orudis )
Piroxicam . (Commonly known as Feldene )
Meloxicam . (Commonly known as Mobic )
Celecoxib. (Commonly known as Celebrex )
Warning . Aspirin (also known as Aspro or Aspro Clear ) interferes with blood clotting and so is not recommended for postoperative pain relief, as it may cause bleeding. If you are regularly taking aspirin ( Cardiprim or half an aspirin daily) on your doctor's advice, you should talk to your surgeon or anaesthetist about stopping the aspirin three weeks before surgery. If you do not take aspirin regularly, you should avoid it for three weeks before your operation.
OTHER FORMS OF PAIN RELIEF
Less severe pain can be dealt with using relaxation techniques, breathing exercises, hot or cold packs, massage or TENS (Transcutaneous Electronic Nerve Simulation) machine (gentle electrical stimulation of the skin). Some people find other methods of pain relief such as: hypnosis; acupuncture; and aromatherapy helpful, but in general these methods are less useful in managing postoperative pain. They are probably most useful when used together with the methods discussed above, rather than on their own.
WHEN YOU GO HOME
Some pain relieving drugs may impair your judgement.
Don't drive a car, operate dangerous equipment or tools, make important decisions, sign legal documents or drink alcohol while taking pain relieving drugs.
Arrange for a responsible adult to accompany you home by car or taxi (don't take public transport) and stay with you for 24 hours.
Rest quietly at home and arrange for someone else to care for small children or other dependants.
Local anaesthetics take time to wear off completely. If part of your body is still numb, you need to take care not to injure yourself.
Make sure you have a clear understanding of which medications to take, especially for pain relief. You may need extra pain relief when a local anaesthetic block wears off.
If you have any concerns call your anaesthetist, surgeon or the facility at which you were treated.
For more detailed information about postoperative pain relief follow the link below to Postoperative Pain Relief.
This information has been prepared by Dr G. Eastaugh MMBS, FANZCA and Dr L Eastaugh MBBS, MBA to give you a better understanding of your postoperative pain relief, but cannot replace professional advice regarding your individual circumstances. It is important that you are satisfied that you understand the information regarding your postoperative pain relief. If you are unsure or concerned about any of this information you should talk to your anaesthetist.
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