Post-Anesthesia Care Unit
After your surgery, your surgeon will talk to your family or friends by phone to let them know how you are doing. In the PACU, the nurses are specifically trained to care for people recovering from surgery and anesthesia and will watch you closely. When you wake up in PACU, the nurse will tell you where you are and that your surgery is over. You may have some blurred vision, dry mouth, chills, or a mild sore throat if general anesthesia and a tube in your windpipe was used during surgery. If you have pain in the PACU after surgery, your nurse will have orders to give you medicine to make you more comfortable. As you wake up, you will be aware of the nurse checking the dressing on your incision, taking frequent blood pressure measurements on your arm, and monitoring your oxygen saturation with a clip on your finger. You will stay in the PACU for at least one half an hour, often longer, depending on the type of surgery you had and the anesthesia you were given. For the privacy of all our patients, no visitors are allowed in the adult PACU.
Pain Management After Surgery
Most patients having surgery at WFBMC have their pain management plans ordered by their surgical team. In fact, most hospitals do not even have a RAAPM team. Luckily at WFBMC, RAAPM doctors who specialize in pain management will visit you daily to help keep your pain under control if your surgeon requests it and if certain of the methods below are planned. Effective pain management is known to be very important for your recovery. That is why it is our opinion that it is best if these plans start prior to scheduling your surgery with a discussion of pain management with your surgeon. We in RAAPM will plan to do everything possible to meet you and your surgeon’s planned request for us to help with the best pain management possible after your surgery.
Your nurse and RAAPM team will ask you to rate your pain before and after you get your pain medicine. They do this because you have an important role as the leader of the team ensuring you get good pain control. We use a scale— either visual or verbal--- such as the one below.
This scale is an important tool to measure how well we are doing with your pain control. Zero is no pain. Remember that “10” is not the worst pain you have had: it is the worst pain you could imagine having. You will have some pain after surgery: we will work with you to make you as pain-free as possible. For more advice on how to control pain, ask your nurse for a free copy of “Pain Control.”
If we are asked by your surgeon to help with your postoperative pain management, we will likely first plan to use some form of regional anesthesia (as described above), placed in the RAAPM area (also as described above) prior to your surgery. After surgery and starting in the PACU, our daily visits may extend until the next day or over several days depending on your surgery and recovery. After surgery, you will likely experience extended pain relief from the anesthesia that you received in the RAAPM area. On the day of surgery and day(s) following, your pain management by RAAPM likely will involve one of these methods:
•Peripheral Nerve Block: numbing medicines given before surgery that last for 4 to 20 hours after surgery to provide pain relief to part of your arm or leg. Pain pills are also available for pain before and after these numbing medicines gradually start to wear off.
•Continuous Peripheral Nerve Block: numbing medicines given to numb up your shoulder, arm, or part of your leg using a small tube near nerves for one to several days. Your nurse will explain that you can push a button to give yourself more numbing medicine, if you need more. You may also ask for pain pills for pain not relieved by the numbing medicines. Certain patients at WFBMC can be discharged from the hospital with a disposal pump administering continuous peripheral nerve blocks at home.
•Continuous Epidural Analgesia: numbing medicines and very small amounts of pain medicines given using a small tube usually in the middle of your back. A button helps you control the amount of medicine you receive. These medicines are directed toward the area of your incision, so they generally leave your legs unblocked allowing you to walk. These types of epidurals are known to decrease complications after surgery in patients with medical problems and maximize recovery of bowel function after abdominal surgery.
•Epidural Extended Release Morphine: pain medicine especially formulated to last 2 days; given though a needle in your lower back before surgery.
•PCA Pump: IV pain medications given when you push a button when you need medicine. The pump is attached to an IV. This is generally used in situations where surgeons have requested no regional anesthesia, regional analgesia was not planned out in advance by your surgical team, regional anesthesia cannot be done safely, or regional anesthesia is unlikely to be effective. Generally, when the RAAPM team uses a PCA pump, it is added to other more effective methods of pain relief or very large amounts of narcotic-type pain medicines are required to control pain using a non-standard PCA.
•Pain Pills and IV Pain Medicines: Your nurse will put the pain medicine into your IV when you ask for it. However, here is an important fact to keep in mind: If your pain management is by the RAAPM team, the pain pills already ordered for you are actually stronger and much longer-lasting than these IV medicines. Many patients think just the opposite! It works out better for most patients if they use pills first whenever possible. Some of the pills you receive for pain management are non-narcotic in nature and are given on a schedule rather than when you ask for them. Although these pills will not usually get the job done on their own, they have been shown to reduce the amount of narcotic pain medicines patients need and to do so dramatically after surgery.
Pain pills take time for your nurse to get to you and then to work. That’s where the IV medicines come in because they have one advantage—they are faster-acting and may help as an addition to the pills. So, do not wait until your pain gets bad to ask for your pain pills. Use pain medicines so that you do not hurt too badly, you can get out of bed, move around better, and do your breathing exercises. This will help you recover faster, prevent lung problems, decrease the chance of a blood clot, and shorten the length of time you might have pain. Because nausea and itching are common side effects of all narcotic-type pain medicines, your RAAPM team will have already ordered these medicines when we wrote your pain medicine orders before surgery. Please make sure to ask for them as well, if you need them.
Good luck for a speedy recovery from the RAAPM team.