Pain Management
Managing pain after surgery is a difficult but necessary step for recovery. Dr. Hinson creates detailed pain management plans for all his patients and is committed to managing pain safely and effectively. Here’s what to expect before, during, and after surgery.
Managing pain after surgery is an important part of recovery. It’s also a topic that makes many people nervous. Fortunately, shoulder and elbow surgeries have progressed to where most are done arthroscopically, resulting in far less pain. (Arthroscopy is a minimally invasive surgery done using small incisions with a small camera and light source.)
Some shoulder and elbow surgeries do still require an “open approach”—meaning a bigger cut with larger scars than is seen with arthroscopic surgery. However, there are effective pain management options available regardless of the type of surgery you need.
Opioid Management
Opioid addiction is a significant problem. In fact, up to 5% of patients who have surgery and have not been on opioids in the past may require professional help to discontinue the medication long after the surgical procedure.
Dr. Hinson is committed to managing pain safely and effectively to prevent opioid addiction. Following surgery, patients should plan on discontinuing opioid medications within six weeks, and sooner if possible. Many patients do not require opioids within two weeks.
Three months after surgery, if opioids are essential from the perspective of the patient, then Dr. Hinson will refer to a pain management specialist for further evaluation and treatment.
The pain management plan before surgery usually includes:
- Eating high-nutrition foods for the best potential for healing at the surgical site
- Stopping all anti-inflammatory medications (e.g., ibuprofen, naproxen, or meloxicam) 1 week before the procedure since these may cause an increase in bleeding during and after surgery
- Discontinuing all opioid medication within two weeks of the surgical procedure. Using opioids prior to surgery increases your risk of requiring professional help to discontinue this medication after surgery.
- Starting the prescribed pain management program the day of surgery before the procedure begins. In collaboration with anesthesia, medications taken before the surgery start the overall pain management process.
Multimodal Approach to Pain Control
During surgery: nerve block
Patients may receive an oral medication to minimize anxiety and discomfort before a local anesthetic (e.g., lidocaine) is injected at the site of the nerve block. Next, a regional nerve block is typically injected around the nerves that go to the patient’s shoulder and arm, which is known as the brachial plexus.
Dr. Hinson routinely uses ultrasound-guided regional anesthesia for shoulder surgery before patients receive general anesthesia. The use of the intrascalene block, which typically eliminates the pain of surgery, allows the anesthesiologist to use a minimal amount of general anesthesia.
Nerve blocks are long-lasting and continue to work for an additional 12-48 hours after surgery. This means that patients will go home and sleep comfortably in their own home. Patients who receive regional and local anesthetics often regain function much faster.
After Surgery: Oral Pain Medications
Because exercise and physical therapy are important parts of a successful surgical outcome, engaging in basic movement early on gives you a headstart on your recovery. As the nerve block gradually wears off, oral pain medications (pills or tablets) may be used to manage any discomfort while you ease back into movement.
After surgery, Dr. Hinson recommends the transition from opioid pain medications to familiar medications such as Tylenol Extra Strength and nonsteroidal anti-inflammatory drugs (NSAIDs) such as Naprosyn (naproxen) or Mobic (meloxicam). Taking the medication on a regular schedule for the first 72 hours will help prevent pain spikes that may otherwise only respond to opioids.
After Surgery: Cold Therapy
Cold therapy should be used to reduce inflammation, pain, and swelling after surgery. This type of treatment can be applied with an ice pack, a bag of ice, or a commercial cold therapy unit. Following surgery, Dr. Hinson will recommend that you use cold therapy to decrease pain, reduce the need for pain medications, and improve your recovery time and results. If you would like a commercial cold therapy unit, it is a self pay item available.
After Surgery: Anti-Nausea Medications
It’s important to control nausea and vomiting after surgery so you can take your pain medications and remain comfortable. Nausea and vomiting have been significantly reduced with modern anesthesia techniques. After surgery, some patients, especially those who have not been exposed to anesthesia before will have a tendency to experience nausea and vomiting. Therefore, patients are provided with a strong anti-nausea medication (i.e., Zofran or odansetron). This medicine is sent before all of Dr. Hinson’s surgeries.
Use of Opioids Before Surgery
Patients who have taken opioid pain medication 3–6 months before surgery, even if only occasionally, have less predictable responses to multimodal pain management. The use of opioids before surgery can lead to uncontrolled pain after surgery with the need to admit patients to the hospital.
For more information about how to manage pain after shoulder or elbow surgery, please request an appointment with Dr. Hinson 561-727-1352 (office)
