What are the latest recommendations to manage pain after surgery?

In my practice my patients are normally started on Vicodin ES once they arrive home or to the aftercare facility. Tylenol #3 may also be used in patients who do not tolerate vicodin. In the past Darvocett N-100 was used for patients who became nauseated with codeine. It however has recently been taken off the market. Interestingly, ice compression of our surgical site (breasts, abdomen, thighs) greatly reduces swelling and pain early on and can be quite helpful. Anxiolytics such as valium can also be used to relax both the mind and the body. Finally, muscle relaxants such as Flexeril is useful on our breast augmentation and abdominoplasty patients who have had subpectoral implants placed or tightening of the rectus muscles.

Often times I am asked to manage patient’s pain following surgery. After discharge the patients hospital dosing of pain medication is considered and then converted to short acting medication such as hydrocodone or hydromorphone (dilaudid). It’s important to continue the round the clock dosing for the first week or so until the pain becomes more manageable. Also after surgery muscle spasm is frequently present and benzodiazepines such as valium can be used to decrease the spasm and anxiety that accompanies increased pain. These drugs are habit forming so a clear plan needs to be outlined so that weaning can begin when appropriate. This will depend on the type of surgery, the amount of pain meds the patient took prior to surgery as well as considering any post op complications if present.

Most recently pain pumps infusing local anesthesia for the first three days after surgery can provide a welcome benefit from the immediate spike in pain following a peripheral extremity surgery. For same day surgery these pumps along with cold therapy application to the surgical area is very helpful in reducing the overall opiate usage. NSAIDs are generally avoided as they can inhibit inflammation which is part of the healing process.