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A Guide for Patients Having Hip or Knee Replacement

Pain Management After Surgery

Pain is an unpleasant sensation that is different for every person. There are many words to describe pain, like “soreness”, “discomfort” or “aching”. Assistance with pain management is provided by the Acute Pain Service, which is run by the Department of Anesthesia. The team includes anesthesiologists and nurse practitioners. Our goal is to make sure you are as comfortable as possible. Good pain control allows you to exercise and progress with your activity, which is important for a successful recovery.

When Do I Treat My Pain?

A pain rating scale helps us communicate and understand the level of pain you are experiencing. It can also help you decide when to do something to relieve your pain. This scale begins at “0” which is “No Pain” and goes up to “10” which is the “Worst Pain”. If the level of pain you are experiencing is preventing you from doing your exercises and being active, you should treat your pain.

Important note

Remember…Managing your pain and being active is important for your recovery.

Types of Pain Control Available

There are several methods of pain control available. Your anesthesia care team will discuss which methods are best for you. We use many of these types of pain medication together to minimize the pain you experience.

The most common pain medications include:

  1. Oral pain medication (opioids)
    • Long acting / slow release opioids, such as HydromorphContin®, OxyNEO®
    • Shorter acting opioids, such as Oxycodone, Hydromorphone (Dilaudid®)
  2. Additional oral pain medication (non-opioid), is also used to reduce the amount of opioids you will need. These medications include:
    • Acetaminophen (Tylenol®)
    • Celebrex®
    • Others
  3. Intravenous Opioids
    • Through a patient-controlled analgesia (PCA) may be used for severe pain (see below)

Opioid medications can cause side effects such as constipation, nausea, drowsiness, dizziness and/or itchiness. Severe pain can also cause some of these side effects, so it is important to treat your pain. If you are experiencing side effects you may not want to eat, drink, or do your regular activities. There are ways to manage these side effects, so let your nurse know if you experience any of these problems. Refer to the section on “Potential Complications & How to Help Prevent Them”.

What is PCOA?

Patient Controlled Oral Analgesia (PCOA) allows you to keep a dose of the short-acting opioids medication at your bedside.

What Are the Benefits of PCOA?

  • FASTER: You do not have to wait for your nurse to bring pain medicine to you.
  • CHOICE: You may choose one or more pain pills (as prescribed by the Acute Pain Service team) to control your pain at times that work best for you (e.g. before exercises).
  • PREPARED: You may be better prepared to manage your pain at home.

How Does PCOA Work?

A labelled bottle with short-acting opioids will be given to you to keep at your bedside. You can decide when and how many pills to take. Call your nurse for a re-fill when the bottle is empty.

Things to Remember

The pain medicine takes at least 30 minutes to start to work after you have taken them. Take them at the earliest sign you are becoming uncomfortable. It is recommended that you take your pain medicine when your pain is greater than 4 out of 10 on the pain scale. Failure to do so may result in more severe pain, which is then harder to control. If the medicine does not control your pain, please tell your nurse. Additional or different pain medicine can be given.

What Will I Do?

You must complete a Patient Pain Diary. The diary will help you and the healthcare team to know how effective your pain is managed.

1. Before you take your pills, fill out the Patient Pain Diary by circling your pain score.

Sample of a patient pain diary. Pain score is marked as around 5 or 6 out of 10.

2. Write down the number of pain pills and what time you took them (1, 2, or 3 pills).

2 pills at 9:30 am

3. One hour after you have taken your pills, circle your pain score on the Patient Pain Diary.

Sample of a patient pain diary. Pain score is marked as around 1 out of 10.

4. When your pill bottle is empty, call your nurse to re-fill the bottle. The pain service team will monitor your dosing and assess your progress daily.

Patient Controlled Analgesia (PCA) for Severe Pain

Intravenous pain medication is sometimes required for severe pain. A pump containing an opioid medication is connected to your intravenous. A dosage of pain medication is delivered when you push a button attached to the pump. The pain pump is programmed to allow you to receive pain medication every 5 minutes if needed.

Side effects such as nausea or itchiness may occur. Medication can be given to manage those side effects so let your nurse know if it is a problem. The PCA can be used for the first 24 hours after your surgery.

Important note

It is important that only you push the button of the PCA pump. Please do not allow family or friends to do this for you because the safety features of the pump will not work.

Epidural Analgesia for Complex Procedures/Cases

An epidural is a tiny tube placed in your back by an Anesthesiologist. It is placed in a space outside your spinal cord and will give a steady flow of medication to help reduce your pain after surgery. Epidural analgesia is considered for patients having bilateral hip or knee replacement procedures or other complex surgeries or for people with challenging pain management issues.

To put the epidural in, your Anesthesiologist will ask you to lie on your side or sit at the edge of the bed. They will freeze an area of your back. A needle is placed into your back and the small epidural tube is inserted. The needle is then removed while the tube remains in place. Medication is given through the tube to provide pain relief. Epidurals are usually inserted before your surgery. After your operation, your epidural will be connected to an epidural pump, which will deliver a steady dose of pain medication.

The most common side effects include nausea, itching, and feeling dizzy. Your legs may also feel heavy and numb. Let your nurse know if you experience any of these symptoms.

Important note

Remember... Good pain control is important to allow you to exercise and recover successfully.

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