Post-Anesthesia Care Unit
After your surgery, your surgeon will talk to your family or friends by phone to let them know how you are doing. In the PACU, the nurses are specifically trained to care for people recovering from surgery and anesthesia and will watch you closely. When you wake up in PACU, the nurse will tell you where you are and that your surgery is over. You may have some blurred vision, dry mouth, chills, or a mild sore throat if general anesthesia was used during surgery. If you have pain in the PACU after surgery, your nurse will have orders to give you medicine to make you more comfortable. As you wake up, you will be aware of the nurse checking the dressing on your incision, taking frequent blood pressure measurements on your arm, and monitoring your oxygen level with a clip on your finger. You will stay in the PACU for at least one half hour, often longer, depending on the type of surgery you had and the anesthesia you were given. For the privacy of all our patients, no visitors are allowed in the adult PACU.
Pain Management After Surgery
Most patients having surgery at WFBMC have their pain management plans ordered by their surgical team. In fact, many hospitals do not have a RAAPM team. Luckily at WFBMC, RAAPM doctors who specialize in pain management will visit you daily to help keep your pain under control if your surgeon requests it, and if certain of the methods below are planned. Effective pain management is known to be very important for your recovery. That is why it is our opinion that it is best if these plans start prior to scheduling your surgery with a discussion of pain management with your surgeon. We in RAAPM will plan to do everything possible to meet you and your surgeon’s planned request for us to help with the best pain management possible after your surgery.
Your nurse and RAAPM team will ask you to rate your pain before and after you get your pain medicine. They do this because you have an important role as the leader of the team ensuring you get good pain control. Since we are unable to directly measure your pain, we use a scale— either visual or verbal--- such as the one below for you to describe your pain level and for us to measure how well we are doing with your pain control.
Zero is no pain. Remember that “10” is not the worst pain you have had: it is the worst pain you could imagine having. Your nurses will define your pain goals, and will assess your pain relief and satisfaction with the methods to control your pain. Unfortunately, we are unable to prevent all pain after surgery, but we will work with you to make you as pain-free as possible. Our goal is to provide relief so that you can move freely, be out of bed and walking when allowed by your surgery, and speed your recovery. You will find that there are also non-medication activities you can do to improve your pain relief. For more advice on how to control pain, ask your nurse for a free copy of “Pain Control.”
If we are asked by your surgeon to help with your postoperative pain management, the RAAPM physicians (Acute Pain Service or APS) will likely first plan to use some form of regional anesthesia (as described above), placed in the RAAPM area (also as described above) prior to your surgery. After surgery and starting in the PACU, our daily visits may extend until the next day or over several days depending on your surgery and recovery. On the day of surgery and day(s) following, your pain management by RAAPM likely will involve one of these methods:
- Peripheral Nerve Block: numbing medicines given before surgery that last for many hours after surgery to provide pain relief to part of your arm or leg. Pain pills are also available for pain before and after these numbing medicines gradually start to wear off
- Continuous Peripheral Nerve Block: numbing medicines given continuously from a portable pump for one or more days to numb your shoulder, arm, or part of your leg using a small tube near nerves. A button may be supplied for you to get additional medication doses, or the drip rate may be adjusted if you need more. You may also ask for pain pills for pain not relieved by the numbing medicines. Certain patients at WFBMC can be discharged from the hospital with a disposable pump administering continuous peripheral nerve blocks at home. If this is chosen, the RAAPM team will give you written instructions, call you every day, and be available 24/7 by phone for any questions.
- Continuous Epidural Analgesia: numbing medicines and very small amounts of pain medicines given continuously through a small tube usually in the middle of your back. A button may be supplied for you to request additional doses. These medicines are directed toward the area of your incision, so they usually maintain strength and movement in your legs and allow you to walk. These types of epidurals are known to decrease complications after surgery in patients with medical problems and maximize recovery of your GI tract after abdominal surgery.
- PCA Pump: IV pain medications given when you push a button when you need medicine. The pump is attached to an IV. This is generally used in situations where surgeons have requested no regional anesthesia, or when regional analgesia could not be done safely or was incomplete or unsuccessful. Generally, your surgeon will prescribe the IV PCA unless higher than usual opioid medications are required and your surgeon has requested the RAAPM team continue to be involved to control pain using a non-standard PCA.
- Pain Pills and IV Pain Medicines: Your nurse will put the pain medicine into your IV when you ask for it. However, here is an important fact to keep in mind: in general, the pain pills ordered for you may be stronger and are definitely longer-lasting than these IV medicines. Many patients think just the opposite! It works out better for most patients if they use pills first whenever possible, and request the IV medicine only as a backup plan for breakthrough pain.
Pain pills take time for your nurse to get to you and then to work. That’s where the IV medicines have an advantage—they are faster-acting and may help as an addition to the pills. So, do not wait until your pain gets bad to ask for your pain pills. Use pain medicines so that you do not hurt too badly, and you are able to get out of bed, move around better, and do your breathing exercises. This will help you recover faster, prevent lung problems, decrease the chance of a blood clot, and shorten the length of time you might have pain. It is also true that too much pain medicine can sometimes make you overly sleepy, slow your breathing, and interfere with your recovery. For this reason, you will often be given other supplemental medications around the clock which are non-narcotic in nature such as acetaminophen. Although these pills will not usually get the job done on their own, they have been shown to reduce the amount of narcotic pain medicines patients need. In addition, because nausea and itching are common side effects of all narcotic-type pain medicines, your RAAPM team will have ordered antidotes for these side effects if you experience them. Please make sure to ask for these antidotes if you need them.
When you have recovered from your surgery sufficiently to consider discharge, your surgical team will prescribe pain medications if needed. You should plan with them to taper your medicines (decrease the dose or lengthen the time between doses) until they are no longer needed for you to move well and continue your recovery.
Good luck for a speedy recovery from the RAAPM team.