Pain relief after major surgery

A primary goal of pain management after major surgery is for you to awaken relatively comfortable and to experience an uninterrupted transition to pain control, but some discomfort is common and should be anticipated after surgery.

Intravenous (IV) pain medication

Before surgery, you'll probably have a slender plastic tube (catheter) inserted into a vein in your hand or arm to give you fluids, sedatives, anesthetics, antibiotics or pain medications. The catheter can be used for delivering pain medications until you can take pills by mouth.

Pain relievers, such as opioids, are usually injected into your IV catheter at regular intervals. Most hospitals also offer patient controlled analgesia (PCA) — a system that allows you to give yourself a fixed dose of the medication by pushing a button. This way you don't have to ask a nurse for each dose of pain medicine.

The PCA system has built-in safeguards to prevent you from overdosing on pain medication. If you push the button more than once within a set period of time, the dispenser ignores the second request.

Epidural analgesia

In epidural analgesia, pain medications are injected through a catheter inserted into the epidural space within your spinal canal but outside your spinal fluid. An epidural catheter is often used for labor and delivery, and sometimes before an operation, such as a cesarean section or a major abdominal surgery.

The epidural catheter can be left in place for several days if needed to control postoperative pain. A continuous infusion of pain relievers, including local anesthetics or opioid medications, can be delivered through the catheter to control pain.

Patient controlled epidural analgesia (PCEA), similar to PCA, enables you to give yourself a dose of the pain medication by pushing a button. It, too, has built-in safeguards so that you don't give yourself too much medication.

Spinal anesthesia

Some surgeries can be done with spinal anesthesia, which involves medications injected directly into the spinal fluid.

Spinal anesthesia is easier and faster than epidural analgesia is, but it doesn't last as long because there's no catheter to allow the administration of additional medication. Your doctor can add a long-acting opioid to the spinal medication that can relieve post-surgical pain for up to 24 hours.

Nerve block

A nerve block uses a local anesthetic to provide targeted pain relief to an area of your body, such as an arm or leg. It prevents pain messages from traveling up the nerve pathway to your brain. Nerve blocks can be used for outpatient procedures or more-involved inpatient surgery.

For pain relief lasting several hours, an injection is used for a nerve block. For longer pain control, a catheter may be inserted for continuous medicine delivery or patient controlled delivery.

Wound infiltration anesthesia

Your surgeon may inject an anesthetic drug at the wound site during the procedure or place a catheter for post-surgical drug delivery. This means of local anesthesia may reduce the use of opioids during your recovery.