Advances in Postoperative Pain Control
Up until a few years ago, I was doing what most surgeons in the world were doing: only prescribing a narcotic pain medication for postoperative pain control. While this worked for decades and will continue to be the method of choice for many surgeons, I have adopted a slightly more sophisticated way of controlling postoperative pain.
There is a lot of evidence that says pain is best controlled before pain even starts. There are two major categories of pain control: medications and local anesthesia. Local anesthesia is best injected before an incision is made. What this means is that if an area is numb before I make my incision, there is actually less pain overall, even after the local anesthesia wears off.
This holds true for medications as well. If there is a pain medication in your system before I make an incision, you will have less pain overall during your recovery. For these reasons, I inject local anesthesia before I make an incision, and I have my patients take pain medications before showing up for surgery.
When it comes to pain medication, there are many different classes but most commonly, surgeons will prescribe narcotics. While this class of medications works well, they come with a LOT of unwanted side effects. Just to name a few, they can cause nausea, vomiting, constipation, insomnia, addiction, respiratory depression, overdose, and even death. In order to decrease the amount of narcotics my patients require, I prescribe a combination of non-narcotic pain medications that are started prior to surgery and continued for about four days. These include acetaminophen, celecoxib, and gabapentin. These three non-narcotic pain medications work well together and significantly decrease pain in the postoperative setting. If patients are still uncomfortable, then they can take a narcotic for break through pain.
Most of my patients take very little and sometimes no narcotic at all after surgery. Utilizing this method has really led to high patient satisfaction and an overall better experience. Let’s face it, surgery hurts so anything that makes things more comfortable is a win even if it requires a little bit more work.
I can confidently say that using this approach has made things so much better that I will never go back to the single narcotic medication approach ever again.