Post-Op Pain Management

Pain Management after Orthopaedic Surgery

Managing pain after surgery is an important part of recovery. It’s also a topic that makes many people nervous. Fortunately, shoulder and elbow surgeries have progressed to where most are done arthroscopically, resulting in far less pain. (Arthroscopy is a minimally invasive surgery, sometimes called keyhole surgery.) 

Some shoulder and elbow surgeries do still require an “open approach”—meaning a bigger cut with larger scars—but there are effective pain management options available regardless of the type of surgery you need. Many patients say that the fear of the pain was worse than the pain itself!

Dr. Romeo has managed thousands of shoulder and elbow surgeries and creates detailed pain management plans for all of his patients. He is committed to managing pain safely and effectively to prevent opioid addiction.

The pain management plan before surgery usually includes

  • Proper dietary preparation
  • Stopping all pain medications and anti-inflammatories 7–10 days before the procedure unless they are essential for your overall health
  • Starting the pain management program the day of surgery before the procedure begins.

“Dr. Romeo has managed thousands of shoulder and elbow surgeries and has detailed pain management plans for all of his patients.”

A multimodal approach to pain control

Dr. Romeo uses multiple types of pain treatments (called “multimodal analgesia”) to reduce pain after surgery. This is because pain travels from the site of surgery to the brain over several distinct nerve pathways. Multimodal analgesia uses different pain-lowering strategies for the various pathways. Pain medications may be administered intravenously, by injection, or by prescription pill.

Before surgery: Enhanced Recovery After Surgery (ERAS) program 

The ERAS program aims to lessen the stress of surgery on the body. It has been shown to reduce complications and shorten hospital stays. The first step of the ERAS program gets patients into the best possible physical and mental state before surgery. 

ERAS also helps address the fluid and nutritional imbalances common with surgery. With traditional surgery, patients cannot eat or drink before surgery, but the ERAS program has them drink one electrolyte-balancing beverage four hours beforehand. This has been shown to prevent nausea and vomiting while increasing the ability to tolerate pain.

During surgery: nerve block

Regional and local anesthetics are given during surgery to block the pain of the surgical procedure. They take less of a toll on the body than general anesthetics, and patients who receive local and regional anesthetics often regain function much faster. Dr. Romeo aims to use regional and local anesthetics as often as possible to minimize post-op pain [TKTK].

A regional nerve block is typically injected close to the nerves of the spine. A dose of pain medication (such as bupivacaine) is given to numb the area being operated on. Local nerve blocks may also be given, and they are typically injected closer to the site of surgery. Nerve blocks are long-lasting and continue to work for an additional 12–18 hours after surgery. This means that patients can often go home and sleep comfortably in their own beds. 

After surgery: oral pain medications 

Because exercise and physical therapy are important parts of a successful surgical outcome, engaging in basic movements early on gives you a head start on your recovery. As the nerve block gradually wears off, oral pain medications (pills or tablets) may be used to manage any discomfort while you ease back into movement.

After surgery, Dr. Romeo may recommend familiar medications such as Tylenol Extra Strength and nonsteroidal anti-inflammatory drugs such as Naprosyn (naproxen) or Mobic (meloxicam).

After surgery: cold therapy

Cold therapy can be used to reduce inflammation, pain, and swelling after surgery. This type of treatment can be applied with an ice pack, a bag of ice, or a commercial cold therapy unit. Following surgery, Dr. Romeo may recommend that you use cold therapy to decrease pain and improve your recovery time and results.

“Good post-op pain management begins before surgery.”


Is there anything I can do before surgery to help my post-op pain levels?

Yes! Good post-op pain management begins before surgery. Patients will receive oral pain medications before surgery, have a nerve block administered, and follow an Enhanced Recovery After Surgery (ERAS) program customized to shoulder replacement and rotator cuff procedures.

Will postoperative pain management put me at risk of opioid addiction?

In a recent study, Dr. Romeo and his team looked at a large national database of patients to determine the risk factors for opioid addiction after shoulder surgery. They found that one out of seven patients who did not use opioid medications before surgery but took them at the time of surgery was still using them six months later. This risk was higher for those who were on opioids before surgery, had a history of depression, or drank alcohol regularly.

Fortunately, Dr. Romeo uses a multi-pronged approach to significantly reduce this risk by ensuring you do not become overly dependent on one type of pain relief medication. When opioids (such as oxycodone and hydrocodone) are prescribed as part of a comprehensive pain management strategy, Dr. Romeo is careful to limit their amount and duration and monitor any signs of dependency. Using the multimodal approach, patients generally do not need opioid medications after 7–10 days except in special circumstances.

What if I already use narcotics to control my pain?

Patients who have taken opioid pain medication 3–6 months before surgery, even if only occasionally, have less predictable responses to multimodal pain management. This also seems to be more of a problem with patients who smoke or are hypersensitive to pain. Please let Dr. Romeo and his team know if you are concerned about these important issues.

For more information about how to manage pain after shoulder or elbow surgery, please request an appointment with experienced Chicago orthopaedic surgeon Dr. Anthony Romeo. Call or email our office today to schedule your visit.

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