While some postoperative pain is to be expected after orthopedic surgery, the intensity and duration of that pain is unique to each patient. At Hospital for Special Surgery (HSS), all patients are seen and monitored by an anesthesiologist and surgical team after surgery in order to gauge pain and customize comprehensive pain management care.
Even before the surgery begins, your anesthesiologist is looking for ways to minimize the severity of your postoperative pain. At HSS we usually use a “multimodal” pain relief approach, where a variety of pain-relieving techniques are used to provide comfort. This is why approximately 90% of HSS’ joint-replacement surgeries are done under regional anesthesia, a type of anesthesia that is associated with less pain after surgery. (Don’t worry; you typically receive sedation during the surgery as well!) Your anesthesiologist will review your case and medical history and after discussion with you will determine the best possible anesthetic approach prior to your surgery.
Regional anesthesia is just one method of pain management – often times, your anesthesiologists will combine peripheral nerve blocks (a type of regional anesthesia that numbs specific nerves and can provide long-lasting pain relief) and patient-controlled analgesia (PCA) pumps during the initial recovery stage. A variety of specific medications are also used for pain control. Every effort is made to come up with a way of safely controlling your pain that limits potential side effects. Although opiate-based pain medications remain the single most effective treatment of moderate to severe postoperative surgical pain for most people, your postoperative pain control is designed to use these medications in the lowest effective dose for the shortest period of time.
If the type of surgery you are having includes admission to the hospital at least overnight, your pain treatment will most likely be monitored by the Acute Pain Service (APS). The APS is led by an anesthesiologist and is made up of nurses, physician assistants, and other providers who specialize in pain management. These providers are available 24/7 to patients admitted to HSS under APS care. Sometimes surgeons chose to care for your pain with their own pain management techniques outside of the care of the APS.
For patients with special needs regarding pain management (e.g. pre-existing chronic pain/opiate usage, medication intolerance/sensitivity, substance abuse, difficulty with pain control in the past) the Department of Anesthesiology at HSS has the resources to coordinate and customize your pain care before surgery as well as after discharge from the hospital. Please contact the HSS Department of Anesthesiology if you need access to these resources.
The goal of surgical pain relief isn’t to eliminate pain entirely in the days immediately following surgery. The Acute Pain Service practice is to coordinate with physical therapists and nursing staff to ensure that postoperative pain is controlled well enough to safely and effectively start rehabilitation and get you back in the game.
Reviewed on August 14, 2018.
Dr. Philip J. Wagner, MD, is an anesthesiologist and the associate director of the Acute Pain Service for the Department of Anesthesiology.