Pain Management after Joint Replacement Surgery
Assistance with pain management is provided by the Anaesthetist and the surgical/medical team on the ward. Our goal is to make sure you are as comfortable as possible. Good pain control allows you to exercise and progress with your activity, which is important for a successful recovery.
We sometimes use a pain rating scale where 0=No pain and 10=worst pain. You may be asked to rate your pain using this scale. This helps us measure the success of the medication in reducing your pain to an acceptable level.
There are several methods of pain control available. Your anaesthetist will discuss which methods are best for you. They include:
- Oral pain medication & multi-modal analgesia (see below)
- Nerve blocks
- Patient-controlled analgesia (PCA)
Oral Pain Medication & Multi-modal Analgesia
There are several different types of oral pain medication (taken by mouth) available. You will be given several different types of pain pills on a regular basis. This is called “multi-modal analgesia”. Each pill works differently in your body and reduces the need for stronger pain medication, such as morphine. If the medication does not control your pain, please discuss this with your nurse. Additional or different pain medication can be given.
A nerve block is an injection of local anaesthetic or “freezing” medication near the nerves that give sensation to your surgical site. This makes the area feel numb and pain free. It provides several hours of postoperative pain control and can be used along with a spinal or general anaesthetic. In some cases, a small tubing is left in place to provide a continuous flow of freezing medications for pain control beyond 24 hours.
Your anaesthetist will locate the specific area for the nerve block using special equipment called an ultrasound or nerve stimulator. They will then numb the skin with some local anaesthetic. You may feel a slight “sting” from this. Next, a short needle is inserted. You will feel some twitching movements, which are normal, and shows us we are in the right spot. Your anaesthetist will then inject the local anaesthetic. You may notice a warm, tingling sensation. Your limb will then become weak and feel heavy and numb.
Benefits of nerve blocks:
- Reduces the amount of other strong pain medication needed
- Avoids the side effects associated with other pain medication such as nausea, vomiting and drowsiness You may be able to eat and drink sooner after your operation, especially if general anaesthetic is avoided
- Provides long-lasting pain relief with minimal side effects
Risks of nerve blocks:
Motor block – your limb will feel numb and heavy, this is temporary and it means that your block is working
Bruising or bleeding at the site of the injection
Failure of the block – your anaesthetist will rectify this immediately with another injection or through other forms of pain relief
Temporary nerve injury – you may continue to have numbness and weakness which may last up to 6 weeks. This will eventually improve
- permanent nerve injury – this is numbness or weakness lasting 6 months or longer Infection at the site of injection
- • Local anaesthetic toxicity – local anaesthetic may be injected into the blood stream, causing ringing in the ears and a metallic taste in the mouth – these symptoms are not harmful and will soon go away, but please let your anaesthetist know if you experience them
Your Anaesthetist will assess the need for the following:
Patient Controlled Analgesia
Patient-controlled analgesia (or PCA) is a pump containing pain medication. It connects directly to your intravenous line and provides fairly rapid pain relief. The PCA allows you to control your pain safely and effectively, by pushing a button when you experience pain. The pump will “beep” and deliver a small dose of pain medication. The pump is programmed to allow pain medication every 5 minutes, with a maximum dosage allowed per hour. This means you cannot take too much. The dosage of pain medication can be adjusted, so let your nurse know how well your pain is controlled.
It is important that only you push the PCA button, not friends or family members. The PCA is used for the first 24-48 hours after your surgery. Side effects, such as nausea or itchiness, may occur. Medication can be given to relieve these symptoms.
Remember….Good pain control is important to allow you to exercise and recover successfully.