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​Surgery

Acute Pain Service

The Acute Pain Service is a multidisciplinary team comprised of anesthesiologist, anesthesia assistants trained in acute pain management, in-patient nurses and pharmacists.  The goal of the Acute Pain Service is to assist patients through their surgical recovery by minimizing pain and reducing post-operative complications.

The type of pain management employed is determined by a number of factors, including type of surgery, type of anesthetic and most importantly, specific patient's needs.  The specific therapies employed to manage pain may include:  oral medication, intravenous self-controlled pain pumps, regional anesthetic blocks or epidural infusions.  The Acute Pain Service team will work with each patient to develop the best strategy to optimize their post-operative recovery with your surgeon and other health care providers.

 

Post-operative Pain Management Education for Patients

 

The management of post-operative pain begins at home with the development of reasonable expectations and goals for pain relief.  Although absolute avoidance of pain following surgery would be ideal, the reality is that some discomfort is likely unavoidable.  However, with the use "multi-modal" (medications from different classifications) therapy and non-pharmacologic techniques, the Acute Pain Service will ensure that our patients have level of pain that is manageable and allows for a safer and quicker recovery.

Each patient within the Acute Pain Service will have the opportunity to discuss their individualized pain management plan with a dedicated anesthesiologist or anesthesia assistant in their pre-surgery appointment or the day of surgery.  Part of that discussion will include the type of anesthetic utilized, such as spinal, neuraxial anesthesia, general anesthesia, regional anesthesia or epidural anesthesia/analgesia.

Immediately prior to surgery, Acute Pain Service patients will be provided with several oral medications.  This "multi-modal" therapy will be continued throughout the per-operative period and works to minimize narcotic (opioid) use. 

 

Advantages of Multi-Modal Pain Management include:

 

Reduces the dependency on narcotic (opioid) drugs to achieve adequate pain management

Reduces the overall side effects of the medications (i.e., drowsiness, nausea)

Allows patients to feel more alert following surgery

Allows for earlier ambulation

Allow for earlier progression of diet (i.e., clear fluids to full diet)

Allows for earlier return of normal bowel and bladder function

Decreased incidence of confusion post-operatively

Earlier recovery and discharge home

Although each patient's medications will be tailored to their particular surgery, anesthetic and pre-existing medical condition(s), patients will be provided with around the clock medications for a number of classifications (multi-modal) including:  anti-inflammatories, acetaminophen, long acting capsules and stronger tablets used for "breakthrough" pain.  "Breakthrough" pain is pain that is not effectively managed with scheduled medications alone.  Typically this type of pain may be associated with an increase in activity, such as physiotherapy or ambulation.  Patients are encouraged to speak with their nursing staff and take additional medications as needed to promote optimum comfort.  By providing these medications around the clock, pain is managed and side effects are minimized.  Although it may seem strange to have nursing staff wake patients to take medications, the regular dosing has been proven to be more effective and well tolerated.

Medications provided by intravenous or epidural routes are often used in conjunction with oral tablets to provide additional analgesia for patients requiring them.  Patient Controlled Analgesia pumps and Patient Controlled Epidural Analgesia pumps are an option that allow the patient to push a button that is attached to the intravenous line or epidural, which then delivers a small effective dose of medication.  These devices have multiple pre-set, safe limits and are used exclusively by the patient.  Nursing staff and family are not allowed to touch the pump control button.  Patient Controlled Epidural Analgesia is a method often used for patients undergoing large abdominal, urologic or vascular surgeries, as well as for mothers in the birthing unit.  The anesthesiologist, anesthesia assistant and nursing staff will provide additional education for patients with these systems to ensure that patients understand how to effectively use them.

There are also a number of other pain management techniques to improve patient comfort.  These can include application of cold or heat packs, relaxation techniques, distraction (television, music and games) or activities that patients find relaxing and therapeutic.


Assessing Your Pain

 

Pain is not easy to measure.  Each patient room is equipped with a "white board" that your nurse will explain on arrival to the area.  There are a number of "faces" at the bottom of the board, which help in assigning a numeric value or pain score (0-10) to your discomfort.  Your pain score will help the nursing staff determine the most effective medications to administer to improve your comfort.  These pain scores will also be used by the Acute Pain Service team to evaluate how effective any changes to your multi-modal therapy have been.  Staff will be asking you with each visit how comfortable you are and how effective your pain medications are.  It is important that patients communicate with the nursing staff to ensure that comfort is achieved.

Nursing staff will also be focusing on the type of pain that patients are experiencing and may ask questions about the "quality" of the pain.  Is it burning, sharp, throbbing, and aching?  Where is the pain?  Does it travel to other parts of your body?  Is there a certain position that makes you feel better or worse?  How effective are the pain medications when you take them?  All of these questions will assist the nursing staff to effectively manage your post-operative pain.

Patients are encouraged to speak to the anesthesiologist, the anesthesia assistant and nursing staff about any questions related to their pain and treatment while at RVH.

References

RVH – Information for Patients Having Surgery – Spinal / Epidural Anesthesia
RVH – Information for Patients Having Surgery – Regional Anesthesia, Upper and Lower Extremities
RVH – Pain Management – Patient Controlled Analgesia
RVH Department of Anesthesia
Pasero, C., McCaffrey, M.  Pain Assessment and Pharmacologic Management.  Mosby.  St. Louis. (2011)