Post-operative information

Analgesia (painkillers) are one of the most important things to discuss at the preoperative visit. Every surgery & patient is individual, so a plan will be made taking into account the likely operative pain & any preexisting/regular analgesics being taken, as well as allergies. This being said, some general principles apply. 

Analgesics work best when taken regularly, so pain isn't allowed to build up in the immediate post-operative period. 

We usually prescribe simple analgesics to be taken regularly, then tapered off over time, with a higher strength analgesic for any "breakthrough" pain i.e pain that occurs even when taking the regular painkillers.

Most post-operative pain problems occur when patients stop taking the simple analgesics regularly, or discount their likely effectiveness. The pain then builds up & is harder to treat.

For painful operations, you may be kept in hospital for a short time. This allows us to treat pain using specialist drugs & methods.

These might include high strength opioids, patient controlled analgesia (PCA), nerve blocks & others. 

We will discuss these treatments on an individual basis.

All patients in hospital will be prescribed regular analgesia as outlined below, & the nurses on the ward will provide you with them. Please ensure you take what's prescribed even if you are pain free to prevent build up of pain.

This is the mainstay of post-operative simple analgesics. Very few people have any contraindications to taking it.

It works best when taken as 1g (2 tablets) four times a day. This usually means spacing it out regularly over your waking hours, with a gap for sleep.

Paracetamol is very cheap, e.g Boots the chemists sells it for approx 40p a box of 16. If you want to avoid hospital prescription charges, stock up on this prior to surgery.

Ibuprofen & the other NSAIDS (e.g Naproxen & Diclofenac), all work in the same way, & are equally as potent, therefore we tend to use Ibuprofen as our NSAID of choice.

These drugs are highly effective simple analgesics, & work especially well when used in combination with Paracetamol. They do not interact, & can be taken at the same time.

Ibuprofen is taken as 400mg (usually 2 tablets, but there are some high strength preparations), three times a day. It does not matter if you alternate it with Paracetamol, or combine it, but ensure you don't exceed the maximum dose.

Ibuprofen can have effects on some peoples stomachs, & is usually avoided for patients who have had gastric/duodenal ulcers, kidney failure & heart failure. It is sometimes prescribed in combination with a drug to prevent acid overproduction (proton pump inhibitor).

It is also a cheap drug. Over the counter preparations (branded) often claim extra pain relief, but their is limited evidence of this. If you want to stock up on Ibuprofen prior to surgery, buy the generic (non-branded) versions for around 50p a box.

We usually provide a stronger opioid for "breakthrough" pain at home.

This usually consists of Dihydrocodeine or Tramadol. Peoples responses to these drugs varies due to the way the body breaks them down. Some people can be made very sleepy by them, & others counterintuitively find they don't work well. We will discuss previous experiences with you to tailor the right drug regime.

On occasion you may be sent home with a short course of Morphine or Oxycodone. It is important not to try to get a resupply of these drugs if you are still in pain, but rather to make an urgent appointment to see your surgeon again to ensure nothing is wrong. These drugs can be highly addictive in the longer term, so we deliberately limit their supply.

There are lots of non-drug treatments for pain that work well in the post-operative period.

Ice or Heat: using cold compresses or hot water bottles applied to the area of pain is often beneficial. Do not use these over a numb area (e.g after a nerve block), as it may cause a burn.

Cryocuffs can be particularly useful for pain after knee & shoulder surgery. They can be purchased or rented.

Elevation: Swelling often increases pain, increasing blood flow from an affected area helps reduce this swelling. Legs can be raised on pillows when lying down, arms can be similarly elevated above the heart.

Mindfulness & Meditation: If you are not a practitioner, there are lots of great apps to help get started. Headspace is highly recommended for this. If you would like a 30 day trial of this, including a pain management programme, please contact us for a referral.