Post-Operative Pain Management at Crestwood

Undergoing surgery can be a frightening experience. Top on patient’s list of concerns is the possibility of experiencing excruciating pain afterwards and the fear that their pain may not be adequately treated. Some degree of discomfort is to be expected, but this should be very tolerable and allow for a smooth and hopefully uneventful recovery. Of course, some surgeries are associated with more post-operative pain than others.

The cornerstone for post-operative pain control involves administering narcotic medications such as morphine and dilaudid through an IV catheter. The major disadvantage to the use of narcotics alone in the immediate post-operative period is that they are associated with a host of very unpleasant side effects, including nausea and vomiting, itching, sleepiness, and urinary retention. In light of this, the anesthesiologists at Crestwood are major believers in regional anesthesia, which involves placing medication close to the bundle of nerves that supply the area of the body where the surgery is being performed. This medication numbs that area in very much the same way that a dentist numbs your mouth. In most instances, the area will be numb for a number of hours, sometimes as long as 24 hours after a single injection or even longer if a catheter is left in place for continued delivery of medicine.

While there is an additional injection or shot before the patient goes to sleep, the benefits are well worth it. In most cases, the patients wake up after surgery and require no narcotics, which greatly reduces the incidence of nausea and vomiting.  These patients are also more alert in recovery and are ready to go home sooner than patients who receive only narcotics for pain control. For patients spending the night in the hospital, they can typically expect to be pain free for as long as the block lasts (12-24 hours or longer), which at a minimum will allow them to rest comfortably the night following surgery.

Performing regional anesthesia does require some technical expertise and it is a skill that not all anesthesiologists master.  When performed correctly, the discomfort is minimal and the risks are extremely low. The physicians in Crestwood’s anesthesia department perform more than 100 blocks per month and their success rate for achieving a successful block is far above average.

The most common surgeries for which regional anesthesia is suited include orthopedic and podiatric cases, where the entire limb on which the surgery is being performed can be blocked. Of course, most of these patients prefer to be asleep during the actual operation so most of them also receive general anesthesia during the case. The level of anesthesia required though is far less because the area of surgery is insensate to painful stimuli (ie a surgeon’s knife).

Over time the block will resolve and the numbness will dissipate. Fortunately this occurs after the most painful period has passed. At this point the pain can typically be managed with narcotics that can be given orally along with other medications, such as Tylenol and non-steroidal anti-inflammatory agents (NSAID’s), such as ibuprofen..