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Safety & Side Effects

Non-Narcotic Approaches to Pain Management

Narcotic drugs used to treat pain have many side effects ranging from nausea and vomiting to addiction. While there is a need for narcotics in some orthopedic cases, it’s not a pain control method your anesthesiologist would solely rely on to manage your post-operative pain.

Non-narcotic approaches to pain management include elevation of the body part, which can reduce pain and swelling, to Tylenol and other anti-inflammatories. Sometimes, broad category anti-seizure medications and muscle relaxers are used in tandem with other methods to manage your pain.

Local anesthetics, which are used frequently by anesthesiologists at HSS, are another non-narcotic approach to pain management. Nerve blocks (anesthesia targeted to a specific area of the body being operated on) are injected prior to surgery and keep the body part numb anywhere from a few hours to a few days following surgery. Use of nerve blocks is associated with less pain after surgery which reduces the need for narcotics.

Patients with Prior Issues with Narcotics

Depending on the surgery, narcotic use may be unavoidable. In these cases,  patients should expect some degree of pain, especially following physical therapy, but not too much pain. Patients should only take narcotics when they feel significant pain and avoid taking them when they don’t.

Some patients report prior issues with narcotic pain medication: nausea, vomiting, and constipation. While some patients are more sensitive to these side effects than others, it is important to mention these reactions to your medical provider, surgeon, and anesthesiologist before surgery, so that the best recovery plan for you is put into place.

In some cases, patients undergoing surgery use narcotics regularly and at a high level. It is important to speak with his or her medical doctor, surgeon, and anesthesiologist before the surgery. Sometimes, patients may have to meet with our Chronic Pain team in order to be weaned off of narcotics in order to safely perform surgery.

Nausea & Vomiting After Surgery

Nausea and vomiting are commonly associated with surgical anesthesia. While the reasons for these side effects are complex, the risk of experiencing nausea and vomiting after surgery depends on the type of anesthesia, the procedure itself, and the medications used to treat postoperative pain.

Fortunately, your anesthesiologist has a number of medications to treat this problem, including using regional anesthetic techniques (when possible), administering anti-nausea medications before, during, and after surgery, and providing treatment alternatives that reduce the need for additional medications that are often associated with increased vomiting or nausea.

Female patients, those with a history of motion sickness, and patients with past experience of postoperative nausea and vomiting are at an increased risk of experiencing nausea and vomiting after surgery. If you have concerns, please tell your anesthesiologist prior to surgery and he or she will customize an anesthetic plan to reduce the risk of nausea and vomiting after surgery.

Eating Before Surgery

A nurse will contact you about specific food and drink intake instructions a day prior to your surgery.

An empty stomach significantly decreases the chance of having aspiration, a rare but serious complication of both general and regional anesthesia with sedation. An aspiration is when stomach contents are expelled into the lungs, causing significant damage. Following the specific food and liquid intake instructions from your nurse will lower your aspiration risk.

Spinal & Epidural Safety

A neuraxial blockade (often referred to as an epidural or spinal) with local anesthetic medicines causes a temporary interruption of muscle strength and sensation, but these effects are expected and desired during surgery.

The duration of these side effects is determined by the amount and type of anesthetic medicine given. The amount of local anesthetics used for each procedure is based on the requirements of the surgery and surgeon. These effects wear off over a period of minutes to hours in the recovery room.

Dr. Richard Kahn, attending anesthesiologist, explains the common side effects of spinal and epidurals.

Pain After Surgery

Your anesthesiologist plays an essential role in planning and maintaining your comfort during and after your surgery. Orthopedic surgery often results in postoperative pain. To eliminate pain totally after surgery would require complete anesthesia and would make your rehabilitation much more difficult.

The goal of postoperative pain management is to control the pain and reduce it to a level that does not distract you from your daily activity and enables you to function and participate with your rehabilitation.

Initially after surgery, pain is managed by various modalities, including epidural infusions, local anesthetic infusions near peripheral nerves, or intravenous/patient controlled analgesia (PCA). As pain gradually lessens in the days following surgery, you will be switched to oral medications. Usually, before going home your surgical team will write you a prescription for pain medicine to be taken after you leave the hospital.

Blood Clot Risks

A blood clot can form when the blood vessel wall is damaged. This occurs when the rate of blood flow is diminished, or when there is an increased clotting tendency (hypercoagulability). The rate of blood clot formation varies greatly, depending on the type of surgery. Total hip and knee replacements have some of the highest rates of deep venous thrombosis of the leg.

While most of these blood clots do not cause symptoms, an estimated one in 100 patients having a joint replacement surgery will have a clot break off and travel through the heart to the lungs (called a pulmonary embolus). This can affect circulation and respiration. Epidural anesthesia can reduce the risk of these complications. HSS anesthesiologists are experts in epidural anesthetic techniques.

Smoking, obesity, and estrogen all increase the risk of blood clot formation. You may want to discuss modifying these risk factors with your doctor prior to surgery. Be sure to tell your doctor if you've had a pervious blood clot.

Postoperatively, you can promote blood flow and reduce your risk of blood clots by doing the exercises your physical therapist will prescribe you and walking with assistance as soon as possible. You may be given a medication to make the blood less coagulable and/or given a device that promotes blood flow.

Blood Supply Safety

There are many safeguards on our blood supply to ensure safe blood. First, blood is donated by volunteer donors. Before giving blood, donors must answer questions about their health and risk factors for disease.

Blood from each accepted donor goes through extensive testing. In addition to tests for blood type, nine separate screening tests are run for evidence of infection with hepatitis, HIV, HTLV and syphilis. Then, the blood undergoes a process called crossmatch, where the blood sample is tested against blood from the patient who will receive it. Additional checks are then performed to compare the specific donor unit selected with the patient's blood.

If a blood transfusion is indicated during a surgical procedure or other medical treatment, the risks of not receiving blood far outweigh the risks of transfusion. Some patients may experience minor changes in the body's immune system after a transfusion, causing mild symptoms, such as fever, chills, or hives, which typically require little or no treatment. A small number of patients may also react to donated blood by developing antibodies (immune reactions).

The transmission of disease and the destruction of red blood cells occur only very rarely, and seldom threaten life. You do have choices other than receiving blood from the community blood supply. Autologous blood transfusion refers to procedures in which you may serve as your own blood donor. In preoperative autologous donation, your blood may be collected and stored before a scheduled surgery if blood use may be required. Please speak to your surgeon about autologous blood donations.

In intraoperative and postoperative autologous transfusions, blood lost during surgery is saved and returned to the patient.


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