Overview of Post-Orthopaedic Surgery Pain Management
Managing your pain after surgery is an important part of recovery. It’s also a topic that makes many patients nervous. Fortunately, shoulder and elbow surgery has progressed hugely so many procedures can be done arthroscopically, resulting in far less pain. Some shoulder and elbow surgeries still require an “open approach” (meaning larger scars), but there are great pain management options available. Many patients say that the fear of the pain was worse than the actual pain itself!
As an experienced Chicago orthopaedic surgeon, Dr. Anthony Romeo uses multimodal analgesia to target pain after shoulder surgery. The idea behind this approach is that the pain you are experiencing travels from the site of surgery to the brain over several distinct nerve pathways. The multimodal analgesia technique uses different pain-suppression strategies for the various pathways.
Medications may be administered intravenously, by injection, or by prescription pill. The plan before surgery usually includes proper dietary preparation for the surgery, stopping all pain medications and anti-inflammatory medications 7-10 days before the procedure unless they are essential for your overall health, and beginning the pain management program the day of surgery before the actual surgical procedure.
Dr. Romeo has managed thousands of shoulder and elbow surgeries and has detailed pain management plans for all of his patients. He is also committed to managing their pain responsibly to prevent opioid addiction. However, patients who have taken opioid pain medication within the last 3-6 months before surgery, even if only on an occasional basis, have less predictable responses to our multimodal pain management. This also seems to be more of a problem with patient’s who smoke, or who have a hypersensitive reaction to all types of pain such as when blood is drawn from a needle. Please let Dr. Romeo and his team know if you are concerned regarding these important issues.
Post-Op Pain Management FAQ
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 will receive oral pain medications before surgery, have a nerve block administered, and follow an Enhanced Recovery After Surgery (ERAS) program especially for shoulder replacement and rotator cuff procedures.
How does a nerve block help with postoperative pain?
A regional nerve block is administered using 20 to 40 cc of local anesthetic (such as a slow-release dose of bupivacaine) to “freeze” the area being operated on. The nerve block is long-lasting and works for approximately 12-18 hours after surgery. This means that patients can go home and sleep comfortably in their own beds. In addition to managing the pain that is typical right after a surgical procedure, local and regional anesthetics help get you functional much faster than undergoing a general anesthesia to control your surgical pain. Because exercise and eventually physical therapy will be an important part of a successful outcome, engaging in basic movement early on gives you a head start on your recovery. As the nerve block gradually wears off, oral pain medications may be used to manage any discomfort.
What is an Enhanced Recovery After Surgery (ERAS) program? How does it help?
The ERAS program works with patients to get them into the best possible nutritional and electrolyte state before anesthesia is administered. While patients cannot generally eat or drink before surgery, the ERAS program has them drink one electrolyte-balancing beverage four hours before surgery. This has been shown to prevent nausea and vomiting, while increasing the ability to tolerate pain.
What kind of pain medications can I take after surgery?
The multimodal analgesia approach used by Dr. Romeo relies on familiar medications such as Extra-strength Tylenol and nonsteroidal anti-inflammatory drugs such as Naprosyn or Mobic (Meloxicam).
Will post-operative pain-management put me at risk of opioid addiction?
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 the amount and duration of this medication and monitor any signs of dependency. However, in a recent study, Dr. Romeo and his team looked at a large national database of patients who were having shoulder surgery to determine what could be associated with opioid addiction after shoulder surgery. One out of seven patients who did not use any opioid medications before surgery and then used them at the time of surgery were still using them six months after surgery. The numbers are higher for those who were on these medications before surgery, have a history of depression, drink alcohol regularly, or have depression. Using our multimodal approach, patients will not need opioid medications after 7-10 days except in special circumstances.
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 our office today to schedule your visit.
Anthony Romeo, MD
Dr. Anthony Romeo is one of the nation’s leading orthopaedic surgeons specializing in the management and surgical treatment of shoulder and elbow conditions. His state-of-the-art practice employs minimally-invasive arthroscopic techniques to accelerate the recovery process for a range of challenging conditions.