PAIN MANAGEMENT

The goal of post-operative pain medication is pain control, not pain elimination. You should expect to experience some pain after surgery as this is a normal part of the recovery process. Slight adjustments to your pain management regimen may be necessary after surgery depending on your experience.

​

Narcotic Pain Medication

Narcotics are very strong opioid-based pain medications. Examples including hydrocodone, oxycodone, Vicodin, Norco, Percocet, and OxyContin. When used as directed, these medications are safe and effective. However, these medications are also addictive and are one of the leading causes of accidental deaths in the United States. Many narcotics also contain acetaminophen (Tylenol), which can cause liver failure if too much is taken. For these reasons and others, it is very important that you take narcotics only as directed and do not take more medication than is prescribed for you.

​

Narcotics are for pain control only. They do not help you heal or recover from surgery. After surgery, you will be given a prescription for enough narcotic medication to manage your pain through the first phase of recovery (approximately 1–2 weeks). The later phases of recovery should be managed with non-narcotic pain medications. Once your pain is well controlled with non-narcotic medications alone, you should stop taking narcotics. If you continue to require narcotics to maintain adequate pain control through the later phases of recovery, you should inquire about what other pain management options may be available.

​

If you are receiving narcotic medication from another physician prior to surgery, you should tell your surgeon prior to surgery so that you can come up with a plan for how to manage your medication after surgery.

Common side effects of narcotics include nausea, vomiting, confusing, sleep disturbances, constipation, and drug dependence. It is not uncommon to have nausea and/or vomiting after surgery, particularly for the first 48 hours. These symptoms may be due to the anesthesia or narcotic pain medication. You have been given a prescription for anti-nausea medication called ondansetron (Zofran) that you should take only as needed for postoperative nausea and/or vomiting.

​

To minimize constipation while taking narcotics, you should drink plenty of water and eat plenty of fruit and vegetables. If you concerned about constipation or have developed constipation, you should purchase an over-the-counter stool softener from your local pharmacy and take it as directed with the narcotic. Such medications include dulcolax (Colace), senna (Senekot), (polyethylene glycol) MiraLax, and milk of magnesia.

​

Acetaminophen (Tylenol)

​

Acetaminophen (Tylenol) can be a very effective post-operative pain medication. If you have been prescribed a narcotic pain medication that does not contain acetaminophen, then you may take acetaminophen 650 mg every four hours as needed for pain. Do not take more than 4000 mg of acetaminophen within 24 hours because taking too much can cause liver problems or liver failure. Similarly, if you have a history of liver problems, you should speak with your primary care physician about whether it is safe for you to take this medication.

​

Non-Steroidal Anti-Inflammatory Drugs (NSAID)

​

NSAIDs are medications that reduce pain and control inflammation. Examples include ibuprofen (Advil, Motrin), naproxen (Aleve), (meloxicam) Mobic, diclofenac (Voltaren), celecoxib (Celebrex), and ketorolac (Toradol). In some situations, these medications can be quite helpful for post-operative pain control. However, after certain surgical procedures, it may be better to avoid these medications. You should discuss with your surgeon whether NSAIDs are recommended following your surgery. Common side effects of NSAIDs include upset stomach, stomach ulcers, or gastrointestinal (GI) bleeding. It is important to let both your surgeon and your anesthesiologist know if you have a history of NSAID intolerance, NSAID allergy, or GI bleeding, and you should speak with your primary care physician about whether it is safe for you to take NSAIDs.

​

Medication Refill Policies

​

Requests for medication refills should be made during regular business hours and may take up to 48 hours to be processed. Narcotic pain medication refill requests may not be prescribed at night or on weekends. For these reasons, it may be necessary for you to plan ahead if you are concerned about your supply of post-operative pain medication.

​

Elevation

​

If you had knee or ankle surgery, to reduce postoperative pain and swelling, it is important to elevate your lower extremity after surgery. This is particularly important for the first 48 hours after surgery. Your lower extremity does not have to be excessively elevated to the point that it is uncomfortable, but it should be elevated enough so that fluid flows away from your knee.

​

Ice and Ice/Cooling Machines

​

Using ice packs or an ice/cooling machine on your operative extremity after surgery can provide significant pain relief and decrease the amount of narcotic pain medication you will require after surgery. If you received an ice/cooling machine as part of your surgical dressing, you may use this as much as you would like if you find it helpful. If you are using ice packs, you should use ice at least 4-5 times per day for 20 minutes at a time. You should do this for at least the first three days after surgery, although many patients find ice to be helpful for longer after their surgery. Whether you use ice packs or an ice/cooling machine, make sure to place a bandage or thin cloth (a t-shirt works well) between the ice pack/pad and your skin to prevent frost bite. This is especially important if you have had a nerve block and have decreased sensation in your skin.

​