Pain relief after major surgery

A primary goal of pain management after major surgery is for you to awaken relatively comfortable and to transition to pain control. However, some discomfort is common and should be expected after surgery.

• Intravenous (IV) pain medicine. Before surgery, you'll likely have a slender plastic tube called a catheter inserted into a vein in your hand or arm. The catheter allows your healthcare team to give you fluids, sedatives, anesthetics, antibiotics or pain medicines. The catheter can be used for delivering pain medicines 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). PCA is a system that allows you to give yourself a fixed dose of the medicine 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 medicine. If you push the button more than once within a set period of time, the dispenser ignores the second request.

• Wound infiltration anesthesia. Your surgeon may inject an anesthetic drug at the wound site during the surgery. Or your surgeon may place a catheter to deliver pain medicines after surgery. This may reduce the use of opioids during your recovery.

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

  Spinal anesthesia is easier and faster than epidural analgesia. But it doesn't last as long because there's no catheter to allow the delivery of more medicine if needed. A long-acting opioid may be added to the spinal medicine to relieve 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.

• Epidural analgesia. Pain medicines 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. It sometimes is used before an operation, such as a cesarean section or major abdominal surgery.

  The epidural catheter can be left in place for several days if needed to control pain after surgery. A continuous infusion of pain relievers, including local anesthetics or opioid medicines, 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 medicine by pushing a button. It, too, has built-in safeguards so that you don't give yourself too much medicine.