Ask the Expert: Dr. Philip Wagner, Anesthesiologist, Answers Your Questions on Managing Post-Operative Pain

by Dr. Philip Wagner
Anesthesiologist

Q1. I am looking at spinal fusion surgery in a few weeks. I am worried about recovery time, and want to be up walking as much as possible as soon as possible. What should I expect and what do you recommend I request from the doctor for pain meds?

How you do from a recovery point-of-view depends on a variety of factors, including your age, the type and extent of your surgery, your pre-operative physical condition, and your medical and surgical history. “Bigger” surgeries take longer to recover from — a discussion with your surgeon before surgery would be helpful in giving you a better answer to specific to your situation. For patients at HSS, from a post-operative pain control perspective, almost all patients undergoing spinal fusion are seen by the HSS Acute Pain Service (APS) after surgery. The APS consists of a dedicated team of physicians and nurse clinicians who tailor patients’ pain regimen to facilitate their early ambulation and recovery. Usually patients start off with on-demand intravenous pain medications delivered via a Patient Controlled Analgesia (PCA) pump, and then make a transition to oral medications within the first few days. Medications are adjusted specific to patients in order to get the best possible pain control while minimizing side effects.

Q2. I’m going to have surgery next month and will be under general anesthesia. Does it matter when I stop eating or drinking before surgery to avoid pain after surgery?

Before any surgery, as a general rule you are not supposed to eat solid food after midnight prior to your surgery, but you can have “clear liquids” (i.e. any fluid you can see through such as water, tea, black coffee or apple juice) up until 3 hours before your scheduled surgery time. Any medications you are instructed to take before surgery can be taken with a sip of water. Opiate-based medications (like Percocet or Vicodin) that you take on a regular basis can be taken before surgery as well. These “fasting” rules exist to ensure that your stomach is empty before surgery, thus reducing your risk of complications — the guidelines don’t really have any effect on your pain after surgery. You should consult with your physician about preparing for your surgery.

Q3. After someone wakes up from anesthesia, how long does it take for the person to be fully coherent and safely drive?

Most people are awake immediately after their surgery here at HSS, but this depends on the duration and type of surgery and type of anesthesia. All patients discharged from HSS are required to have someone accompany them home, and the minimum time recommended to drive is 24 hours. Time to drive will also depend on recommendations from your surgeon related to your surgery as well as types of pain medication prescribed. If you are taking opiate-based pain medications (e.g. Vicodin, Norco, or Percocet) for postoperative pain control you cannot drive safely. Consult with your physician about when you can safely drive after your surgery.

Q4. I’m going to have ACL surgery soon. Is there anything I can do before the surgery to reduce the pain after surgery?

Being in the best possible physical condition before surgery will help you to recover faster. If you smoke, you should stop now. There are no other proven things you can do personally before surgery to lessen your post-operative pain.

Q5. I’m getting foot surgery in two months. Is there a difference in the level of pain that people experience for regional and general anesthesia?

Dr. Philip Wagner, Anesthesiologist

Dr. Philip Wagner, Anesthesiologist

Although we have very effective techniques for managing post-operative pain regardless of the type of anesthesia patients have, most patients prefer waking up from surgery with an effective regional pain block in place. When long-acting pain blocks are used, patients can often have many hours to days of effective post-operative pain relief with minimal use of opiate-based pain medications. Regional anesthesia can get patients over the period when they would be experiencing the most severe pain. Consult with your physician about the best type of anesthesia for you.

Dr. Phillip Wagner is an anesthesiologist at Hospital for Special Surgery.

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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

Myra Lieberman says:

Dr.
My orthopedist referred me to your hospital. I was a professional ballerina with a company. I need a knee replacement. I had one on my other knee 8 years ago and was treated like an old person not one who is still active and work out at my ballet barre daily. I am now 64. The last time my regional anesthesia went fine but I had problems with post op meds. I couldn”t tolerate the morphine or Demerol. I ended up getting 10 mg Of Percocet only. It was tough. Is it unreasonable to expect a better outcome ? I must have a problem with everything from morphine to codeine. I am not 80 but here they see replacement for people who are inactive. Can I expect better there?

HSS on the Move says:

Hi Myra, thank you for your question. Dr. Wagner says, “A person”s response to surgery and pain medications can vary greatly, even from surgery to surgery. At HSS we strive to treat everyone as an individual. It would probably be worthwhile for you to meet with one of our anesthesiologists after your surgery is scheduled to discuss your options for postoperative pain control.” You can also read one of our publications about caring for the working artist: http://www.hss.edu/files/Horizon-Spring-2011-Annual-Report.pdf

Kasandra Lahue says:

Acute pain might be mild and last just a moment, or it might be severe and last for weeks or months. In most cases, acute pain does not last longer than six months, and it disappears when the underlying cause of pain has been treated or has healed. Unrelieved acute pain, however, might lead to chronic pain.

angel lopez says:

Hey, I have an assignment I have to do for one of my classes. Im suppose to interview a person who works in the medical field and I would like to know if I could e-mail you some of the questions.

HSS on the Move says:

Hi Angel, thank you for reaching out. Please contact us at socialmediacontact@hss.edu for further assistance.

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