Postoperative Pain Management
Postoperative Pain Management Treatment Options:
Several types of medications are available for the management of postoperative pain. Examples include:
- Opiates, ex. Morphine, Dilaudid, Percocet, Lortab
- Non-steroidal Anti-inflammatory Drugs (NSAIDs), ex. Toradol
- Acetaminophen (Tylenol)
Intravenous opiates, such as Morphine or Dilaudid are typically administered through a patient-controlled device allowing you to self administer a predetermined amount of medication. These are changed to oral medications as your recovery progresses.
Thoracic Paraverterbral Nerve Block
The thoracic paravertebral nerve block is a technique whereby a local anesthetic is injected in the vicinity of nerves emerging from the spinal column in the thoracic region. It results in anesthesia and analgesia to the chest wall area.
This particular nerve block is most commonly performed for patients undergoing breast (mastectomy and cosmetic breast surgery) and thoracic surgery. It can be administered to one or both sides of the body and the specific location and distribution of anesthesia and analgesia are a function of the level blocked and the amount of local anesthetic injected. Also, a catheter can also be inserted for continuous infusion of local anesthetic.
With paravertebral nerve blocks, the potential side effects of general anesthesia such as postoperative nausea and vomiting are avoided and patients often feel little or no pain. Any existing pain can be easily managed with medications. These nerve blocks do not result in loss of motor function and thus, do not impair a patient's ability to ambulate or care for herself following surgery. In addition, the injection of small amounts at several levels decreases the risk for local anesthetic toxicity.
Several local anesthetics can be used. However, the use of a long-acting local anesthetic provides the greatest benefit for pain relief. A commonly used local anesthetic, 0.5% Ropivacaine, has an onset time of 15-25 minutes and provides analgesia for 8-12 hours.
Continuous Wound Infusion
For patients whose surgery involves the abdomen, the surgeon may place a device, such as an On-Q pain pump, to administer a low dose local anesthetic continuously near the incision site. With this system, the infusion pump administers the medication through small catheters that are placed at the incision site by the surgeon near the end of surgery. When used to deliver local anesthetics to or around the surgical wound site, this type of device can significantly decrease postoperative pain and narcotic use and can be used for many days, even at home.