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