What will happen after the operation?
You should discuss postoperative pain relief with your anaesthetist before the surgery. You may well have a PCA (Patient-Controlled Analgesia) device. This allows you to receive strong painkiller directly into the circulation via a pump whenever you require it, simply by pressing a button. You cannot receive too much because the device will be limited by the anaesthetist to a dose which is safe for you.
Your surgeon will also put some long-acting local anaesthetic into the wound if this is appropriate. Local anaesthetic catheters (fine tube) can be useful for reducing the pain from smaller operative sites and you should discuss this with your surgeon. These can be left in for a day or two.
What types of drugs are used?
Some procedures are relatively painless and will require only simple analgesia such as Codydramol or Cocodamol (paracetamol and a weak opiate such as morphine type of drugs).
We can add in anti-inflammatories such as Ibuprofen (Brufen or Nurofen) or Diclofenac Sodium (Voltarol), but we are keen to avoid these in limb reconstruction since they delay bone healing.
In more major procedures, we will use stronger drugs such as OxyContin, Tramadol, Morphine or Diamorphine. These can have the disadvantage of making some patients feel off their food or nauseous, delirious or sleepy. They can also cause constipation and breathing problems. So we do try to tail these off as soon as possible.
Spinal anaesthetics (epidural) are injections into the spine to make you numb from the waist down. They normally last for two hours. If your operation will take less time, it may be appropriate for the operation period, but is not usually used for post operative relief.
An epidural catheter (fine tube) can be inserted around the nerves leaving the spine and left in for a few days, in a similar procedure to the spinal anaesthetic. We try to avoid these in limb reconstruction, because there is a risk that the signs of compartment syndrome could be covered up by the total numbness that results from epidurals. Compartment syndrome is a rare build up of pressure in the leg or forearm that needs to be released immediately. It is only detectable by rising levels of pain.
While you are in hospital you will have regular visits from the pain teams who will monitor your pain and advise on the particular combination of drugs to manage your pain levels. You will also be sent home with a prescription for your combination of pain relief. Make sure you also have the contact details of who you should call if you find you are not able to manage your pain when you get home. In an emergency go to your nearest accident and emergency department.