Managing Pain - Surgical Guide to Left Posterior Total Hip Replacement Surgery - HSS | Hospital for Special Surgery

How Does It Feel?

Recovering from any surgery involves pain and discomfort. The Hospital's team approach to pain management can help reduce your discomfort and thus speed your recovery. Pain management, however, begins with you. Since no objective tests exist to measure what you are feeling, you must help the staff by describing the pain, pinpointing its location and judging its intensity, as well as reporting any changes. Pain may be constant or sporadic, as well as sharp, burning, tingling or aching. A pain scale is used to help you and the staff gauge the level of pain and effectiveness of treatment.

People used to think that severe pain after surgery was something they "just had to put up with." While it is reasonable to expect some discomfort following surgery, the current treatment options greatly reduce the level of pain most patients have.

Your description will help us provide you with a plan of care. Even under your personal pain management program, your pain level may change at times. Be sure to tell your nurse if it becomes worse.

You will be asked to rate how much pain you have on the pain scale below and what your tolerable level of pain is:

Your Treatment Plan

Pain control following surgery is an important part of your care. The pain management team will use a multi-faceted approach to manage your pain. This may include a combination of nerve blocks, oral medications, injections, IV medications and catheters connected to computerized pumps with a button that is controlled by the patient (Patient-Controlled Analgesia or PCA). We try to refrain from giving injections, but sometimes this is unavoidable. Our goal is to recognize and treat pain quickly to allow full participation in the exercise program.

The goal is to transition you to oral pain medications. Usually the oral pain medication is an opioid or narcotic, but whenever possible, an anti-inflammatory medication will be ordered as well. This transition is usually a smooth one, enabling you to progress with your activities with minimal discomfort. A short course of prescription pain medication may be recommended at discharge. You will be instructed to use as needed and directed and how to gradually taper. More information will be provided prior to discharge from the Hospital.

Every patient's experience is unique. If you need pain medication, tell your nurse as soon as the pain starts. Keep in mind that your pain is easier to control if you do not allow it to become severe before taking pain medication. Usually medications are available every 3 to 4 hours as needed.

Please let us know if your pain is not getting relieved. We want you to be as comfortable as possible while you heal. Being able to participate in your own recovery activities is a goal of the recovery process.

It is extremely important that you inform your anesthesiologist about any problems encountered with medications of any type in the past, and if you are currently using prescription medications for pain.

What Is Patient-Controlled Analgesia (PCA)?

PCA is a type of pain medication delivery system which utilizes a microprocessor (computerized pump) to give a prescribed amount of medication at desired intervals. A special pain management team consisting of anesthesiologists, nurses and pharmacists supervises your use of the medication.

The pump is programmed to deliver a pain medication either when you push the button (demand dose) or by a continuous flow (basal rate). It can be attached through either your intravenous line or epidural tubing in your back during your surgery. It is called "Patient Controlled" because, if needed, you can press a button attached to the pump to give yourself a dose of pain medication.

Precautions against an overdose have been incorporated into PCA. The pump is programmed not to deliver the dose of pain medication requested if it is not time to safely do so. There is an hourly limit of medication available. The PCA system automatically records both the doses delivered and denied. Your nurse checks this machine frequently and records the amount of medication used. If you are having pain after using your PCA hourly limit, tell your nurse. The nurse can call the anesthesiologist or other members of the pain management team who will check on you and adjust the medication or PCA settings as needed.

The nurses regularly check on you to evaluate your level of pain relief and assess for side effects. An anesthesiologist visits daily when you are on the PCA pump, even if your pain management is going well. If any problems arise, an anesthesiologist is on call 24 hours a day, 7 days a week.

Epidural PCA

Patients who have surgery on the hips or knees may have epidural anesthesia. After a local anesthetic injection, a catheter (very thin tubing) is placed in your back for administering the anesthesia for your operation. Afterwards, by starting a flow of pain medicine through this catheter, pain relief can be continued into the postoperative period. The PCA is attached to the epidural catheter in your back. As described above, you will be able to give yourself an extra dose of medication, if needed, to make the pain tolerable.

IV PCA

If the anesthesia used for your surgery was not epidural anesthesia, or if your surgeon and anesthesiologist feel an IV is the preferred method of applying pain control, the PCA pump will be attached to IV tubing. This means that the PCA pump will be programmed to inject pain medication directly into your blood stream. Again, you can give yourself an extra dose of medication, if needed, just by pressing the button attached to the PCA pump.

Local Injections During Surgery

Some surgeons prefer to treat pain during the surgical procedure by injecting a combination of medications directly into the tissues close to the surgical site (local).

Oral Medication

After surgery, as pain decreases, you will be given oral pain medication to control any discomfort and pain.

Cold Therapy

The application of cold has been shown to reduce swelling and pain associated with inflammation at the surgical site. Ice packs or cold pads should be applied for 20 minute intervals every 3 to 4 hours on a daily basis for the first few weeks following surgery.

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