Recovery

Pain Management

Please note that this is a general guide. Your physician’s instructions are specific to you; therefore, if your physician gives you instructions that conflict with the information here, please listen to your physician.

Comfort Goal

The nurse will help you set an appropriate comfort goal and explain the pain rating scale. Reporting your pain as a number helps the health care team assess and treat your pain. You'll be asked to rate your pain on a scale of one to 10, with “one” being minimal pain and “10” being the worst pain you can imagine.

It's not realistic to set a comfort goal of zero (no pain) after a surgical procedure. You will have some discomfort even after minor procedures. Your doctors and nurses want, and need to know, about any pain that isn't under control. Our goal is to help you manage your pain so you can participate in all the activities of your recovery, such as deep breathing, coughing, walking or sitting in a chair.

Types of Pain

Sometimes pain is felt in other areas after surgery in addition to the incision. You may feel discomfort in these areas:

• Muscle aches and pain in the back, shoulders or chest from lying on the operating table
• Sore or scratchy throat from the breathing tube placed during surgery
• Pain at the incision site when you move about, such as sitting up, coughing and walking
• If you had a laparoscopic procedure, you may experience referred pain in your upper back or shoulder from air pushing against the diaphragm.

Patient-Controlled Intravenous Analgesia (PCA)

PCA is a system that allows you to administer your own pain medication immediately by pressing a button. Advantages include:

• no painful injections
• no delay in getting your medication
• immediate and more consistent pain relief
• the tendency to use less pain medication than those who receive pain shots
• Pain medication dose and frequency are set by your physician. If you push the button too soon, you will not receive the medication.

Epidural Infusions

Many people are familiar with epidural anesthesia because it's frequently used during childbirth. A post-operative epidural may be considered for some surgeries. Some patients aren't candidates for epidurals because of specific underlying illnesses or medications. Epidurals usually offer superior pain relief and don't normally cause sedation or drowsiness.

Epidurals may be placed using local anesthesia while you're awake or during surgery while you're asleep. The provider places a very tiny catheter into the epidural space in your back. Medications are given through this catheter, which is secured with tape. You may lie on the catheter without disturbing it or experiencing discomfort.

Nerve Blocks

Pain relief may be provided by a nerve block. A long-acting anesthetic is injected into a specific area, which keeps the area numb for several hours after surgery. This block significantly reduces the amount of pain medication needed. In some cases, a nerve block may be used for the anesthesia for the surgery, but you'll also be given medications during your surgery to keep you sleepy.

In some instances, a tiny catheter may remain to provide a continuous block. If you receive a continuous block, you'll need help to get up. If you go home before the catheter is removed, education will be provided. Examples of blocks include spinal, bier block and peripheral nerve blocks.

Oral Pain Medications

Most oral medications can be taken every three to four hours. Request your pain medication when you're beginning to feel uncomfortable - don't wait until your pain is severe. If you'll require pain medication at home, you'll be given a prescription for pain medication before you leave the hospital. The hospital does not fill outpatient prescriptions. Planning ahead to have your prescription filled after you leave the hospital is an important part of your home care.

Post-Op Exercises & Activity

Postoperative exercises are extremely important. Activity stimulates circulation and deep breathing speeds recovery. Don't wait to be prompted - ask your caregiver if you can begin activity. Remember that you're part of your health care team.

Ask for help if you need to move around. Some exercises you can do on your own, such as deep breathing and coughing.

For Your Lungs

Deep breathing and coughing help prevent pneumonia after surgery. Take a slow, deep breath and hold it for a second or two, then push the air our of your lungs with a deep, strong cough. For abdominal or chest surgeries, place a pillow over your incision and apply gentle pressure to this area as you cough. This helps support your incision and lessens your discomfort. You may be asked to use an incentive spirometer. This is a small plastic device that encourages you to breathe effectively. Your preadmission nurse will teach you how to use the spirometer if needed.

For Your Circulation

Walking will help you recover faster and return to normal. Be sure to have help the first few times you get out of bed and begin walking. Don't overdo it. Gradually increase your activity.

Turn from side-to-side or side-to-back, unless this is not allowed with your surgery. Change positions every one to two hours - it helps your lungs and your circulation when you move around.

Your risk of forming a blood clot increases whenever the movement of blood is sluggish or if the blood vessel is diseased or damaged. To help prevent this from occurring, do these exercises every one to two hours when you are awake:

1. Push your toes toward the foot of the bed. Relax both feet. Pull your toes toward your chin. Relax both feet.
2. Make circles with both ankles. Bend each knee alternately, sliding your foot up along the bed. Relax.

Your doctor may order sequential compression devices (SCDS) with plastic sleeves that fit around your legs and a motor that attaches to the sleeves with tubing. This motor inflates and deflates the sleeves, which increases the blood flow in your legs.

Foot pumps are a sleeve that fits around your foot. Similar to SCDS, this device has a motor that attaches to the sleeves with tubing. This motor inflates and deflates the sleeve which increases your blood flow. The sleeves can be removed when you walk, bathe or leave your room for tests. It is important to reapply the sleeves when you return to bed.