The Acute Pain Management Service (APMS) is a team of anesthesiologists and registered nurses who manage certain types of postoperative pain therapies in the hospital setting. The surgeon is primarily responsible for each patient's pain control. Depending upon the type of surgery and the patient's medical history, however, some patients may be candidates for specialized analgesic technologies provided by the APMS. While the APMS is managing the pain, an anesthesiologist will see the patient daily, and an experienced pain nurse will be available to assist in assessment of pain and any adjustment of the medication as needed. We will ask that you rate your pain on a scale of 0 to 10, with 10 being the worst. Our goal is to keep your pain rating below 5; while we do not expect you to be completely pain-free, your pain should be controlled so that you can do all the things necessary for your recovery.
The following are descriptions of some of the services we provide.
Epidural analgesia for pain control after surgery
Used for years as the preferred method for treating obstetric pain, epidural analgesia is an elegant, safe and effective way of relieving pain after surgery in the chest, abdomen and lower limbs. Epidural analgesia involves a continuous infusion of pain medication through a small catheter, which is inserted into the spine. This medication directly targets pain-transmitting nerves in the spinal cord rather than traveling through the bloodstream. Epidural analgesia often provides better pain control, less sedation and a better ability to breathe deeply. In most cases, patients will be able to move and walk sooner than with intravenous analgesia.
An epidural is placed with the patient awake, before the actual surgery. The anesthesiologist will usually provide some sedation in the IV before the epidural is put in. It is generally not very stressful to have an epidural placed.
Regional nerve blocks for pain control after surgery
Nerve blocks are a localized form of pain management used to numb pain signals
from a limb after surgery. Prior to your surgery, your anesthesiologist will
administer the nerve block by injecting local anesthetic solution near nerves
that supply sensation to the surgical site. As the block begins to wear off
- usually after 8-12 hours - you will be given additional pain pills to keep
your pain under control.
In some cases the anesthesiologist will leave a catheter at the site of the nerve block and patients are given a pump with an infusion of local anesthetic to the nerves near the surgical site; this will keep some of the nerve block active for a longer period of time. The local anesthetic solution used for the infusion is not as strong as the original block so the patient will have some sensation and ability to move the limb.
Spinal pain medication for pain control after surgery
For some surgeries (hip/knee replacements or C sections) a long-acting morphine
preparation may be injected along with some local anesthetic medication into
your spinal fluid for pain control after surgery. The local anesthetic part
of the spinal injection wears off in about 2-3 hours. The long acting morphine
preparation lingers on and can provide effective pain relief for 18-24 hours.
Long-acting morphine can sometimes cause itching or nausea; however, there are additional medications that can be given to help with these side effects. Your surgeon will order additional pain medication for the remainder of your hospital stay.
It is important to remember that not all types of pain management are for everyone. Please consult your physician and your anesthesiologist to learn which form of pain management is most suitable for you.