Your Guide to Pain Relief for Surgery

Anaesthesia and Pain Relief during Surgery

  

Very few of us enjoy the sensation of discomfort. From head aches to period cramps, we loath them, and heavily rely on trusting pain killers for quick relief. It's no surprise then, that the fear of pain following surgery is one that is very much high up on the list. In fact, it's not uncommon for individuals to ultimately decide against cosmetic surgery for this reason alone.

Let's face it, pain is an inevitable reality for those who choose to undergo life changing procedures. The good news is, it is indeed possible to help manage and control the experience, keeping discomfort to a minimum and no longer then necessary. In today's blog post, we cover the medication's that may be used during your surgery, and offer options of pain relief to help you cope during those first unrestful days.

During your pre-op assessment, the anaesthesiologist will take details of your medical history to help determine which form of anaesthesia, method of administration and dose will be required for your surgery. It is important to be clear and honest in order to decide the safest options for your current health. The anaesthesiologist will make note of any existing conditions or illnesses, supplements and vitamins, personal factors such as your BMI, any allergies, and of course the procedure(s) you will undergo. 

Drugs During Surgery 

Although not technically pain relief, it is important to be familiarise yourself with the drugs that are administered during surgery. This helps to understand and anticipate how your body may react right after and during the recovery period.

Sedation

 A sedative (a sedation medication) is administered with the purpose of eliminating agitation and anxiety ahead of a surgical procedure. This puts the person in a state of drowsiness but allows the person to stay awake. Levels of sedations can be classed as minimal, moderate and deep. Depending on the level of sedative, individuals may or may not have recollection of the event once the sedative has word off. Even with a deep sedative, there is level of conscienceless unlike general anaesthesia. Sedations are often used for minor or short operations where anaesthesia isn’t necessary, or to calm nerves ahead of  more extensive and complex ones. It may be administered via an IV (intravenous therapy) directly placed into the vein, intramuscular injection or ingested orally. As with all medication, side effects may effect some people. These may include, feeling sluggish, headaches, low blood pressure and nausea. Some examples of popular sedatives are; Ativan (lorazepam), Vallum (diazepam) and Versed (midazolam).

In some countries such as the Dominican Republic, midazolam is commonly used at the beginning of surgery and often known as the “blue pill”. This muscle relaxant takes up 20 minutes to spring into action when administered orally and may remain active for 1- 6 hours. Following the procedure, it may take a further 2.5 hours for the medication to be eliminated by the body. Once the blue pill is ingested, your surgeon will follow this with either a general anaesthetic or a regional anaesthesia. 

 

Local & Regional Anaesthesia 

Local and regional anaesthesia (also known as a nerve block), are often used interchangeably to describe anaesthesia administered to a specific region of the body. The main difference between the two is regional anaesthesia involves a larger part of the body compared to local anaesthesia. To put this into context, local anaesthesia would mean a small site (eg. finger only) being injected with the drug, whereas regional anaesthesia would result in a loss of sensation throughout the whole arm. In both cases, the medication is injected at the site of the procedure, numbing the area yet keeping the individual fully awake. Both Local and regional anaesthesia often share the same drugs/medications but used in larger quantities for a stronger effect.

An epidural is an example of a regional anaesthesia that is administered in the spine and commonly used during labour . A catheter is placed in an area surrounding the spinal cord and delivers a steady amount of medication at intervals when necessary. With an epidural, the individual is not able to feel any sensations below the waist. This makes it ideal for surgeries only in this region. Side effects that are associated with an epidurals include but are not limited to, temporary or permanent nerve damage, headaches and nausea.

 

General Anaesthesia

General anaesthesia works by blocking nerve signals in the brain and body, preventing you from feeling any sense of pain on any part of the body. This medically induced coma puts you in a state of unconscious where you become unresponsive and unaware. A person under anaesthesia is unable to recollect any memory of the the event. Additionally, it causes the paralyses of all muscles except for the bowel, bladder and heart. For this reason patients are attached to ventilators to support and monitor them breathing for the duration of the procedure. This is also why it is necessary to stop eating or drinking at least 6 hours prior to surgery. This is to prevent food being brought back up, usually preventing by the muscles.

As with the other drugs, It is administered by an anaesthesiologist  by gas or IV. General anaesthesia is often preferred by surgeons when a procedure is lengthy, requires work over a large part of the body or may cause anxiety and stress and to the patient. Side effects associated with general anaesthesia includes nausea, a sore throat and/or dry mouth from the ventilator, dizziness, confusion, itching, bladder problems, muscle aches and chills and shivering. More serious risks include being allergic to the anaesthesia, waking up during a procures and death, although rare (1 out of 100,000 cases)

Pain Relief After Surgery

Analgesic drugs is the general term used to describe medication that provide pain relief. Although they are not limited to just these three, in this article we’ll be discussing the most common variants, NSAID, OPOIDS and acetaminophen. 

OPIOIDS

Opioids, known as narcotics, are medications prescribed by doctors used to treat moderate to severe pain. They work by attaching themselves to opioid receptors in the brain and spinal, preventing pain signals from being transmitted to the brain. Low amounts of opioids may cause drowsiness whilst higher amounts can results in an increased heart rate, shallow breathing and a loss of conscience. These are usually ingested orally or IV and present the risk of addiction if taken over a long periods of time. Some well known opioids in order of strength include fentanyl, oxycodone, morphine and codeine.

NSAID

NSAID (non steroidal anti inflammatory drugs) are widely used to treat common discomforts associated with pain, high temperatures and inflammation. They operate on a chemical level by blocking an enzyme called cyclooxyrgenase (COX). This prevents the release of prostaglandin which decreased the swelling of surrounding tissues thus, reducing nerve signals to the brain. Blocking COX interferes with platelets causing blood thinning properties and prohibits blood clots. This is why most surgeons will request patients to avoid these drugs prior to surgery. Ibuprofen and aspirins are examples of some well known NSAID’s that most have us have used and can be purchased over the counter. Other forms such naproxen and oxaprozin as may require a prescription from a doctor. When these are ingested, they affect the whole body and not just the site of pain. Consequently, gastrointestinal problems are a common side effect from using these drugs. Since prostglandins also protect the lining of stomach ,ulcers may develop with high quantities or continuous use. NAID drugs can be presented as pills, creams, gels and sprays.

Acetaminophen

Acetaminophen is the generic name for paracetamol or Tylenol. Like NSAID drugs, acetaminophen works by reducing minor aches and pains but unlike NSAID, does not reduce swelling or inflammation. It can be purchased in different forms as with NSAID drugs. Acetaminophens are generally safer to take compared to NSAID’s and present lower risk side effects. Some of these include low blood pressure, allergic reactions and damage to the liver if taken in excess. 

 

Combining Analgesics

Sometimes it may be necessary to combine drugs to achieve a more desirable affect since pain differs greatly from person to person. it is advisable to begin with the smallest dose and increase this gradually over time to find the combination that works for you. Regardless of which pain relief you choose, there are some important rules that you must adhere to. To some this may be common knowledge, however, we find it necessary to include this information to prevent any accidental harm or misunderstanding associated with medications.  

IMPORTANT

  1. Please stick to the dose suggested on the packaging and avoid sharing medication with other dolls.
  2. Before proceeding with medication please seek advice from your surgeon prior to consuming and do not take without the knowledge of your surgeon or caretaker for the first 3 days following surgery.
  3. When experiencing intolerable levels of pain, it is best to first request a stronger form of medication from your surgeon before consuming OTC drugs. This is to prevent the possibility of overdosing and/or preventing you from administering higher strengths of medication due to incompatible combinations leading to harmful effects.
  4. NEVER consume with alcohol or other drugs. Do not take drugs of the same group (eg, aspirin and ibuprofen)
  5. Only take it for as long as necessary.
  6. Always do your own research (even after reading this!).

 

 Pain Relief Combinations
To end this post, we'd thought we'd put together a table of of pain relief and common combinations for you to research and choose from. Each combination presents different experiences so it's up to you to decide what works, work wont, and ultimately what you decide to pack with you for your procedure.

Medication

(Generic)

Brand Names

Pain Level

Prescription Required?

 

Ibuprofen

Nurofen, Advil

Mild

No

Acetaminophen

Tylenol

Mild

No

Codeine

Codeine

Mild - Moderate

Yes

Acetaminophen + codeine

Co - Codomol, Tylenol with Codeine

Mild - Moderate

No

Acetaminophene + dihydrocodeine

Co - dydromrol

Mild - severe

Only at low strengths

Oxycodone and Acetaminophene

Percocet

Moderate - Severe

Yes

 

For more combinations; please visit https://www.drugs.com/drug-class/analgesic-combinations.html

 What forms of pain relief have you used in the past? Which ones worked and which didn’t? comment below, we'd love to know!

If you enjoyed and appreciate the effort we put into writing each post, why not share this with a friend who may find it useful too! 

 

- TheCurveCulture.

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