Your doctors and nurses will do everything possible to manage your pain after orthopedic surgical procedures. Your doctor has several options to relieve your pain.
Many types of medications can help you control pain. These include opioids, NSAIDs (non-steroidal anti-inflammatory drugs), and local anesthetics. You can feel more comfortable with medications, allowing you to move more, recover faster from surgery, and regain strength more quickly.
Alternative approaches such as medical hypnosis, acupuncture, and other complementary therapies are becoming more popular as a result of the concerns about opioids. Both surgeons and patients are increasingly choosing these methods to complement conventional medicine. Combining pain management methods is best because the surgeon can tailor the pain control to the individual patient.
Your surgeon will consider several factors unique to your case and situation to manage your pain effectively. Therefore, you must openly share your fears, expectations, and past experiences in pain management with your doctor and nurse.
This article discusses the medications used to manage pain following orthopedic surgeries.
Learn how alternative methods complement a pain management plan:
Alternatives to Manage Pain After Orthopedic Surgery.
Opioid Analgesics
Opioids are used to treat moderate and severe pain. They can be particularly effective in managing short-term post-operative pain when taken as prescribed.
Medical providers and facilities may offer different pain management options, policies, and procedures. Most often, after surgery, opioids are prescribed intramuscularly (IM), intravenously (IV), or orally (PO). When you get home, oral medications are the most commonly prescribed method.
Opioid Dependency
Remember that while opioids can help reduce pain following surgery or an injury, they’re narcotic drugs and are addictive. Use opioids only according to your doctor’s instructions. Stop taking opioids as soon as you feel better. Speak to your doctor if you do not feel better within two days after your treatment.
Opioids Types
Natural opioids, the oldest drugs known to mankind, are produced from the “milk” dried opium poppies. Other types of opioids are manufactured artificially in laboratories. These types of opioids are known as synthetic or semisynthetic.
How Opioids work
All opioids, whether natural or synthetic, work by binding to receptors for opioids in the spinal cord, brain, and gastrointestinal tract. These drugs block pain signals from reaching the brain when they attach to opioid receptors.
The reason why opioids can mimic your body’s endorphins, which are natural painkillers that help you feel better, is because they have a similar structure. The structure’s similarity fools receptors, allowing the drug’s action to flood the area with dopamine. Dopamine is a natural substance that affects your pleasure centers in the brain, producing euphoria and pleasant feelings. The “opioid” effect is produced when large amounts of dopamine flow out as the opioid activates nerve cells.
Opioids and Pain Management
The opioids work quickly to block pain, and they also alter the way that your brain perceives it. Pain relief allows you to get more sleep at night and be more active throughout the day.
Opioids can be administered in several ways, including by mouth, skin, directly into the bloodstream, or under the tongue. They don’t cause bleeding in the stomach or other body areas.
Opioids may cause side effects such as:
- Drowsiness
- Confusión
- Difficulty in breathing
- Nausea
- Difficulty in passing urine
- Constipation
- Itching
Your doctor can treat all of these side effects.
The potential for addiction is a serious drawback of opioids. Many studies have revealed the addictive effects of opioid misuse.
Treatment of Opioids
An anesthesiologist, or nurse anesthetist, may use opioids with other prescription medications to help you sleep during certain surgeries. In the recovery room, opioids may be administered to reduce pain after anesthesia.
After you leave the recovery area, several options exist for pain relief.
Oral pain medication.
Due to the growing concern about opioid abuse, oral opioid medications are increasingly used for pain management after surgery. By taking the medication orally, small amounts are absorbed by the stomach and intestines over time. This can provide pain relief for a longer period without having to give more medication than necessary.
You can gradually reduce the dosage of oral opioids that you were prescribed in the hospital and surgical center.
Patient-controlled analgesia pump.
Doctors sometimes administer opioid medications after surgery using a PCA Pump. You can press a button and release a small dose of medicine via an intravenous tube (IV) when you feel pain.
The PCA pump will deliver medication to you at the dose prescribed by your physician. You must wait a certain amount of time after each dose before administering another. The PCA device won’t deliver medication if you press the button prematurely. You will not receive excessive pain medication if you do this.
Opioids, Over-the-Counter Drugs
Some pain medications combine opioid drugs with other pain medicine like aspirin and acetaminophen. You may accidentally receive high doses of acetaminophen and aspirin if you take them in conjunction with pain medication prescribed by your doctor. This can be dangerous, especially for those with liver or kidney disease.
Talk to your doctor about your medication, including over-the-counter medications, vitamins, and supplements. Any of these medications may cause an adverse reaction depending on the type of pain medication you are taking. Your doctor will let you know which over-the-counter medicines are safe for use with prescription pain medications.
Non-steroidal anti-inflammatory drugs
NSAIDs are used to reduce inflammation and pain. They can be taken alone or in combination with opioids for moderate to severe pain. NSAIDs and opioids are commonly used to manage moderate to severe post-surgery pain. NSAIDs can include ibuprofen and naproxen.
How NSAIDs work
NSAIDs prevent an enzyme from functioning (a protein that triggers changes within the body). It is cyclooxygenase (COX), and there are two types. COX-1 protects stomach lining from acidic substances and digestive chemicals. It helps to maintain kidney function. COX-2 is released when the joints are inflamed or injured.
COX-1 enzymes and COX-2 play an important role in the production of prostaglandins. These are responsible for causing pain and swelling when they irritate your nerve endings. NSAIDs block COX enzymes to stop the body from producing too much prostaglandin. This reduces pain and swelling.
The Advantages and Disadvantages Of NSAIDs
NSAIDs have fewer side effects than opioids. NSAIDs can reduce the need for opioids after surgery and reduce side effects such as constipation or drowsiness. NSAIDs do not cause addiction or dependency. However, NSAIDs cannot relieve moderate or severe pain after surgery.
Aspirin and ibuprofen are common traditional NSAIDs. They block COX-1 enzymes and COX-2, causing stomach upset, bleeding, and ulcers. Traditional NSAIDs include ibuprofen and aspirin.
COX-2 Inhibitors are a subcategory of NSAIDs. These medications only target COX-2, the enzyme that triggers inflammation. These medications do not generally cause stomach problems like traditional NSAIDs because they don’t block COX-1. COX-2 inhibitors can have cardiac side effects.
Non-opioids with Central Acting
Acetaminophen
Acetaminophen, like NSAIDs, can be used to reduce the amount of stronger opioid pain medications that you require after surgery. Acetaminophen and opioids are often combined in tablet form. Opioids are not readily absorbed when taken as tablets. When combined with acetaminophen, the medication is absorbed easily and relieves moderate-to-severe pain after surgery.
Acetaminophen has no anti-inflammatory properties because it does not inhibit COX-1 and COX-2 enzymes. Scientists believe acetaminophen reduces mild to moderate discomfort by raising your body’s pain threshold. It helps your body to eliminate excess heat.
Acetaminophen is effective for minor aches, pains, and fevers but not for inflammation or swelling associated with muscle strain.
Tramadol
Tramadol, a synthetic opioid, is manufactured in a lab based on the popular opioid codeine. It is an opioid by definition, but how it acts in the body makes it different from other opioids.
Tramadol works in two different ways to relieve pain. In one sense, Tramadol works on the brain and spine to alter how the body perceives pain. Tramadol works similarly to some antidepressants, interfering in regulating neurochemicals like serotonin and norepinephrine. The amount of these chemicals change, making it difficult to relay pain messages from one nerve to another. It reduces your pain.
Tramadol is effective for moderate pain when combined with acetaminophen and NSAIDs.
Like all drugs, Tramadol can cause side effects such as dizziness, seizures, and nausea.
Local Anesthesia
Local anesthetics are used to block pain in small areas of the body. They can be used in orthopedic surgeries as anesthesia for a surgical procedure or to manage pain after the surgery.
Local anesthetics can be given as a shot or multiple shots near the surgical incision. They can also be administered through an epidural tube placed in your spine. These drugs block pain signals traveling along your nerves and into your brain.
Local anesthetics don’t cause side effects like drowsiness or constipation. They also do not have the breathing problems you get from opioids. Local anesthetics are commonly used in orthopedic surgery. These include bupivacaine and ropivacaine.
Local anesthetics can cause allergic reactions, nerve damage, muscle spasms, and convulsions. Most side effects are avoidable if you tell your doctor your medical history.
Regional Anesthesia
Regional anesthetics can provide pain relief and anesthesia for the duration of surgery.
The nerves of the body part undergoing surgery are injected with medication.
The medication may block movement and feel in your lower body (epidural, spinal), in your arm (interscalene supraclavicular axillary), or in your leg (femoral sciatic).
You may only need light sedation if you are conscious. Regional blocks can be used as a supplement to general anesthesia. You will feel little to no pain after waking up.
Spinal and Epidural
Neuraxial blocks are used to provide spinal and epidural blocks. They block movement and feeling below the level where they are administered, usually the lower part of the spine. They can numb an area that extends from the lower abdominal and pelvis to the toes.
The spinal injection is a single injection into the spinal canal of either a local anesthetic or morphine. It is a single injection, so the effect lasts for the duration of surgery but will only last a few days after.
Anesthesia epidural is administered in the area surrounding the spinal canal. The dura is a membrane that covers the canal. The medication will travel through the dura to reach the spinal cord nerves. After surgery, a small catheter or tube may be placed around the dura. The catheter can be used to administer medication at regular intervals.
Even with a catheter, epidural anesthesia affects the motor nervous system less than spinal anesthesia. This allows for some mobility and function.
Women often receive epidural anesthesia during childbirth, in addition to orthopedic surgery.
The most common is severe itching and nausea when opioids are administered via the spine. Respiratory depression is the most severe side effect, meaning you breathe shallowly and slowly. Your surgical team will monitor you closely for several hours to address or prevent any side effects.
