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Managing pain after surgery is crucial for recovery. Dr. Romeo creates detailed pain management plans for all his patients and is committed to managing pain safely and effectively. Here’s what to expect before, during, and after surgery.

Managing pain after surgery is an important part of recovery. It’s also a topic that makes many people nervous. Fortunately, shoulder and elbow surgeries have progressed to where most are done arthroscopically, resulting in far less pain. (Arthroscopy is a minimally invasive surgery done using small incisions with a small camera and light source.)

Some shoulder and elbow surgeries do still require an “open approach”—meaning a bigger cut with larger scars than is seen with arthroscopic surgery. But there are effective pain management options available regardless of the type of surgery you need. Many patients say that the fear of the pain was worse than the pain itself!

Dr. Romeo has managed thousands of shoulder and elbow surgeries and creates detailed pain management plans for all of his patients.

A note on opioids

Opioid addiction is a significant problem. In fact, up to 5% of patients who have surgery and have not been on opioids in the past may require professional help to discontinue the medication long after the surgical procedure.

Dr. Romeo is committed to managing pain safely and effectively to prevent opioid addiction. Following surgery, patients should plan on discontinuing opioid medications within six weeks, and sooner if possible. Many patients do not require opioids within two weeks.

Three months after surgery, if opioids are essential from the perspective of the patient, then Dr. Romeo will refer to a pain management specialist for further evaluation and treatment.

The pain management plan before surgery usually includes:

  • Eating high-nutrition foods for the best potential for healing at the surgical site
  • Stopping all anti-inflammatory medications (e.g., ibuprofen, naproxen, or meloxicam) 7 to 10 days before the procedure since these may cause an increase in bleeding during and after surgery
  • Discontinuing all opioid medication within two weeks of the surgical procedure. Using opioids prior to surgery increases your risk of requiring professional help to discontinue this medication after surgery.
  • Starting the prescribed pain management program the day of surgery before the procedure begins. In collaboration with anesthesia, medications taken before the surgery start the overall pain management process.

“Dr. Romeo has managed thousands of shoulder and elbow surgeries and has detailed pain management plans for all of his patients.”

A multimodal approach to pain control

Dr. Romeo uses multiple types of pain treatments (called “multimodal analgesia”) to reduce pain after surgery. This approach works because pain travels from the site of surgery to the brain over several distinct nerve pathways. Multimodal analgesia uses different pain-lowering strategies for the various pathways. Pain medications may be administered intravenously, by injection, or by prescription pill.

Before surgery: Enhanced Recovery After Surgery (ERAS) program

The ERAS program aims to lessen the stress of surgery on the body. It has been shown to reduce complications, shorten hospital stays, and help patients manage postoperative pain. The first step of the ERAS program gets patients into the best possible physical and mental state before surgery.

ERAS also helps address the fluid and nutritional imbalances common with surgery. With traditional surgery, patients cannot eat or drink after midnight on the day of surgery. The ERAS program, however, has them drink one electrolyte-balancing beverage four hours before surgery is scheduled to begin. This has been shown to prevent nausea and vomiting while increasing the ability to tolerate pain. Furthermore, this has not been associated with increased complications during surgery.

During surgery: nerve block

Patients may receive an oral medication to minimize anxiety and discomfort before a local anesthetic (e.g., lidocaine) is injected at the site of the nerve block. Next, a regional nerve block is typically injected around the nerves that go to the patient’s shoulder and arm, which is known as the brachial plexus.

Dr. Romeo routinely uses ultrasound-guided regional anesthesia for shoulder surgery before patients receive general anesthesia. The use of the intrascalene block, which typically eliminates the pain of surgery, allows the anesthesiologist to use a minimal amount of general anesthesia.

Nerve blocks are long-lasting and continue to work for an additional 12–18 hours after surgery. This means that patients will go home and sleep comfortably in their own home. Patients who receive regional and local anesthetics often regain function much faster.

After surgery: oral pain medications

Because exercise and physical therapy are important parts of a successful surgical outcome, engaging in basic movement early on gives you a headstart on your recovery. As the nerve block gradually wears off, oral pain medications (pills or tablets) may be used to manage any discomfort while you ease back into movement.

After surgery, Dr. Romeo recommends the transition from opioid pain medications to familiar medications such as Tylenol Extra Strength and nonsteroidal anti-inflammatory drugs (NSAIDs) such as Naprosyn (naproxen) or Mobic (meloxicam). Taking the medication on a regular schedule for the first 72 hours will help prevent pain spikes that may otherwise only respond to opioids.

After surgery: cold therapy

Cold therapy should be used to reduce inflammation, pain, and swelling after surgery. This type of treatment can be applied with an ice pack, a bag of ice, or a commercial cold therapy unit. Following surgery, Dr. Romeo will recommend that you use cold therapy to decrease pain, reduce the need for pain medications, and improve your recovery time and results.

After surgery: anti-nausea medications

It’s important to control nausea and vomiting after surgery so you can take your pain medications and remain comfortable. Nausea and vomiting have been significantly reduced with modern anesthesia techniques, often using three unique medications during surgery to prevent this adverse reaction to the anesthesia.

After surgery, some patients, especially those who have not been exposed to anesthesia before will have a tendency to experience nausea and vomiting. Therefore, patients are provided with a strong anti-nausea medication (i.e., Zofran) to take as needed for the first 48 hours.

“Good post-op pain management begins before surgery.”

FAQs

Is there anything I can do before surgery to help my post-op pain levels?

Yes! Good post-op pain management begins before surgery. Patients should follow an Enhanced Recovery After Surgery (ERAS) program.

Will postoperative pain management put me at risk of opioid addiction?

In a recent study, Dr. Romeo and his team looked at a large national database of patients to determine the risk factors for opioid addiction after shoulder surgery. They found that one out of seven patients who did not use opioid medications before surgery but took them at the time of surgery was still using them six months later. This risk was higher for those who were on opioids before surgery, had a history of depression, or drank alcohol regularly.

Fortunately, Dr. Romeo uses a multi-pronged approach to significantly reduce this risk by ensuring you do not become overly dependent on one type of pain relief medication. When opioids (such as oxycodone and hydrocodone) are prescribed as part of a comprehensive pain management strategy, Dr. Romeo is careful to limit their amount and duration and monitor any signs of dependency. Using the multimodal approach, patients generally do not need opioid medications after 14 days except in special circumstances.

What if I already use opioids to control my pain?

Patients who have taken opioid pain medication 3–6 months before surgery, even if only occasionally, have less predictable responses to multimodal pain management. The use of opioids before surgery can lead to uncontrolled pain after surgery with the need to admit patients to the hospital.

For more information about how to manage pain after shoulder or elbow surgery, please request an appointment with experienced Chicago orthopaedic surgeon Dr. Anthony Romeo. Call or email our office today to schedule your visit.

Related Topics

  • American Shoulder and Elbow Surgeons
  • American Orthopaedic Association
  • Arthroscopy Association of North America
  • American Medical Association
  • SECEC-ESSSE
  • New England Shoulder and Elbow Society
  • American Orthopaedic Society for Sports Medicine
  • American Academy of Orthopaedic Surgeons