What will happen after the operation?
You should discuss post-operative pain relief with your anaethesist before the surgery. You may 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 tubes) 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 type of drugs are used?
Some procedures are relatively painless and will require only simple analgesia such as Codydramol or Cocodramol (paracetamol and a weak opiate such as morphine type 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 info 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 it 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 of your combination of pain relieve. Make sure you have the contact details of who you should call if you find are not able to manage your pain when you get home. In an emergency go to your nearest accident and emergency department.
Physiotherapy can help in reducing your pain after your
operation and during the treatment period. Exercise and
movement. within your pain controlled limits and as
recommended by you Physiotherapist or Consultant, is
important to help prevent problems from occurring.
The common problems that physiotherapy can help with are:
— Muscle contractures and tightness
— Joint stiffness
— Muscle weakness
— Poor mobility and walking pattern
If you are taking painkillers make sure you give them enough
time to take effect before doing your exercises. You will be able
to move more easily if you pain is well-controlled.
Can I relieve pain without drugs?
Keeping occupied, moving as much as possible, socialising and
being with family and friends all help you to cope with the pain.
Acupuncture may be helpful but is not recommended until
healing of the skin has taken place.
Anxiety increases pain. If you have worries, talk them through with someone.
Depression increases pain, so if you feel you are becoming depressed it’s important to talk about your feelings.
As a result of research through the King’s College Hospital IMPARTS (Integrated Mental and Physical healthcare Research Training and Services) programme, the Limb Reconstruction Unit at KCH has had its long held view confirmed: patients undergoing limb reconstruction surgery have a real need for access to psychological counselling. Rebuild has therefore paid for the development of a patient psychological support service with the assistance of the Consultant Psychiatrist, Matthew Hotopft. of the Maudsley Hospital. Alternatively. if you prefer. a referral can be made by your consultant to your GP.