January 14, 2019
Dr. Anu Bajaj, M.D.

Let’s Talk About Pain

With any surgery, you will experience some discomfort or pain. You have also likely read and heard a great deal about our current crisis with opioid (narcotic) use and the recent law passed in state of Oklahoma that limits the number of opioid pills a physician can prescribe to manage acute post-operative pain.

 

What you should know is that opioids are only one class of medication used to manage pain. Other classes of medication that can manage pain as well or even better than opioids include anti-inflammatories, regular Tylenol, neuro-modulators, and long-acting local anesthetics. Traditionally, opioids have been the primary method for managing pain because of their low cost despite their significant adverse side effects, which can include nausea, vomiting, light-headedness, constipation, confusion, drowsiness, and addiction.

 

At Bajaj Plastic Surgery, we believe in a multi-modal approach to acute pain management after surgery. This means different types of pain medications may be prescribed for you. Despite these medications, you may still experience some discomfort, which is completely normal. Pain medication should decrease your discomfort so that you can do the things necessary to allow you to recover from your surgery — walking, taking deep breaths, and maintaining a healthy diet. The goal of pain medication is to help you return to your regular activities as soon as possible.

 

The other good thing about surgery is that the pain and discomfort you may experience is temporary – the first three to five days should be the worst and after that you should require less pain medication and should start to feel better. If you still have a significant amount of pain and require narcotic pain medication after this period of time, you should see your physician because there may be a more serious problem that needs to be addressed.

 

 

What is a multi-modal approach?

 

The concept of multi-modal or “balanced” anesthesia requires the use of different types of medications that act together to help provide you with the best pain relief. Before the surgery even starts, you may be prescribed a combination of pain medications, including Tylenol, Celebrex, and Gabapentin. Tylenol is effective for pain relief when given in sufficient dosage; Celebrex is an anti-inflammatory medication that does not increase the risk of bleeding; and Gabapentin helps the nerve response to pain. By taking these medications prior to surgery, the initial pain response is blunted.

 

After the start of the procedure, the anesthesiologist will begin administering pain medication through your IV to inhibit the pain response. During surgery, Dr. Anureet Bajaj will inject Marcaine, a long-acting local anesthetic, or Exparel (another long-acting anesthetic) at the surgical site(s) to help provide some pain relief for the first day following surgery. Exparel has the potential of keeping your incisions numb for up to 72 hours.

 

What to expect after surgery

After surgery, you will receive several prescriptions for pain medications, including a narcotic (usually Demerol or Tramadol), possibly an anti-inflammatory (Celebrex or Ibuprofen), and possibly a medication for nausea (Phenergan). These medications should be taken as prescribed.

 

Dr. Bajaj recommends you take the Celebrex and Gabapentin (if prescribed) twice daily until your prescription runs out or you are comfortable and no longer need them. Frequently patients will benefit from taking Tylenol every six hours for the first three days after surgery as well. With all of these different types of pain medications, most patients find that they will only require the narcotic for breakthrough pain, if at all.

 

We also would like to remind all patients that as with all prescriptions, keep them in a safe place, do not share your prescriptions, and do not take more than the amount prescribed.

 

Having extra, unused medications at home can also be a hazard. If you have leftover narcotic pain medication that you do not use, please refer to this site for disposal.