Recovering from an operation requires effective pain relief. A key part of anaesthesia is to commence the pain relief regime early in order to support your recovery. Each individual patient has a unique response to surgery. A number of types of medication are available and a combination is usually used to maximise pain relief whilst minimising side effects. A range of techniques including regional anaesthesia (e.g. nerve blocks) may be be utilised in the operating theatre to help achieve effective pain relief and enhance your early recovery process. For more painful operations, the acute pain service will help guide with the use and weaning of painkillers during the recovery period.
Common pain relief medications
Paracetamol is commonly used to provide the first building block of pain relief post operative lay. (It is not usually used in the early stages after liver surgery.) The usual dose is 2 tablets (1g) every six hours (up to 8 tablets/4g every 24 hours). If you are taking panadeine (or panadeine forte), then do NOT add paracetamol to this combination. The dose needs to be adjusted for children, elderly and smaller adults.
Non steroidal anti inflammatory drugs (NSAIDs) include ibuprofen, diclofenac, celecoxib, meloxicam. This type of medication can have side effects if not carefully used, and should be avoided in those with kidney disease, stomach ulcers, some asthmatic patients and older or frail patients. To help reduce risk of side effects, they should be taken on a full stomach.
Antineuropathic pain medications include pregabalin, gabapentin. These can be used in conjunction with the other forms of pain relief. In some situations they can cause dizziness and so are often given at night time to reduce this effect.
Opioids such as morphine, fentanyl, buprenorphine, oxycodone, tapentadol and tramadol all are frequently utilised. These are potent medications with good acute pain relief properties but less long term benefit. Potential side effects include nausea, vomiting, dizziness, constipation, sedation and respiratory depression. We adopt a number of approaches to minimise these side effects. To prevent constipation, we recommend a high fluid and fibre content in your diet whilst on these medications.
Many opioids come in both short and long acting versions. We mostly use one long acting version, and one short acting version on discharge. Whilst the risk of addiction is low, there are still safeguards including the number which we can prescribe on discharge in order to ensure weaning of painkillers.
Slow release opioids include buprenorphine and fentanyl patches, and slow release versions of morphine, oxycodone, oxycodone/naloxone, tramadol and tapentadol.
Local anaesthetics such as bupivacaine and ropivacaine can be used in infusions. These are mostly removed prior to discharge from hospital.
All medications have side effects. Using a combination of different types of pain relief medication allows us to use smaller doses of each, which helps to minimise any negative effect. If you are feeling side effects from your medication it is important to let the nurses or your medical team know so that adjustments can be made.
Weaning regimes for pain relief are unique to each patient, however some general guidelines apply. These are general guidelines only and YOU NEED TO CHECK WITH YOUR MEDICAL TEAM ABOUT WHAT IS SUITABLE FOR YOU. If you are unsure, also check with the dispensing pharmacist.
- Do not take any medication if you have allergies or if you can’t tolerate it.
- There may also be medical or surgical reasons why some pain medications are not suitable for you from the above list
- Cease the long acting opioids first (eg buprenorphine patch or oxycodone/naloxone [Targin])
- Next cease the short acting opioids
- The next ones depend on your tolerance, eg if pregabalin is making you dizzy, consider stopping the daytime dose first, or cease it altogether
- If you were on a NSAID, then cease this next
- For most people, paracetamol is the last one to stop. Be aware if you are less than 70kgs, or elderly, long durations of full dose paracetamol isn’t always a safe option (check with your team)
See attached memory aid for discharge pain relief and other medications