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WHAT SHOULD I KNOW ABOUT POST-OPERATIVE PAIN MANAGEMENT?

BRAIN SURGERY

Pain management is usually not a problem for most Brain Surgery patients. While a "headache" and or incision pain is common, relatively mild analgesics (pain relieving medication) are all that is usually required.

Intensive Care Unit Management

In the early post-operative period, particularly during the stay in the Neurological Intensive Care Unit (NICU), the nursing staff will be conducting frequent Neurological examinations. These examinations BEGIN with an assessment of the LEVEL OF ALERTNESS of the patient. Narcotic analgesics, while generally having the affect of lowering the perception of pain, will cause most patients to become lethargic, stuporous or worse. The nursing and medical staff is then faced with the dilemma to determine if the patient has suffered this neurological deterioration consequent to Brain swelling, an Intracranial Haemorrhage, Hydrocephalus or Intracranial Infection. The cost in additional Neuroimaging tests (CT and/or MRI scans), additional attention from the medical personnel and medications to try to reverse the "deterioration" may be considerable.

Additionally, a lethargic or stuporous patient will fail to breathe deeply in a normal fashion resulting in an increase in the Carbon Dioxide concentration of the blood, the consequence of which is an increase in the Intracranial Pressure (ICP). This has the potential for a life threatening complication.

For these reasons we strongly advise patients to choose carefully when requesting pain relief medication. We do not wish for anyone to suffer pain needlessly and acknowledge that one's ability to tolerate pain varies from one individual to another. Nevertheless, in this unique circumstance, injudicious use could lead to serious consequences.

Access to appropriate analgesics will be available to all patients both during their stay in the NICU, Neurosurgical ward and upon discharge from hospital.

After Discharge

In general, Dr. Lazar recommends that you avoid taking pain relieving medication in anticipation that something you will do is going to cause pain. For pain management, try Extra Strength Tylenol (Acetaminophen). You may be given a prescription for a drug like Vicodin (hydrocodone) or Darvocet N100. DO NOT USE ANY ASPIRIN (or ASPIRIN containing medication) or ADVIL (Ibuprophen) since these medications interfere with the clotting mechanism.

For additional information, please consult our Post-operative Brain Surgery Instructions.

SPINE SURGERY

Pain is a common symptom that accompanies pathological conditions for which most spine operations are conducted. The majority of our patients report that the pain of the operation is less than the pain that brought them to our office for Neurosurgical Consultation. While this is not a universal experience, it is the most frequent one. Most other patients report considerably less pain than the pre-operative condition.

Immediate Post-operative Care

Initial post-operative pain control is achieved in the hospital's recovery Room (or Post-anesthesia Care Unit- PACU) where specially trained nurses are at the bedside to monitor the patient's vital signs as well as administer appropriate medications for pain control.

Patients will have a "menu" of pain relief medication of varying strengths to choose from. These extend in potency from injectable narcotics to intermediate strength oral tablets and to less powerful medications such as Tylenol. It is important to make certain that you are not "over-medicated" in the early post-operative period since the medication may put you to sleep resulting in a failure to breath deeply, which is required to reduce the concentration of residual anesthetic medication that must find its way out of the body before the staff can mobilize you.

We do not want you to suffer needlessly. On the other hand, excessive narcotic analgesic use can lead to significant complications including lung problems.

The following guidelines may be useful to you in managing pain:

  1. PAIN IS A RED FLAG TELLING YOU TO REST.
  2. Avoid taking pain relieving medication in anticipation that something you will do is going to cause pain.
  3. Medications: For pain management, you will usually be given a prescription for a drug like Vicodin (hydrocodone) or Darvocet N100. For additional pain medication, try Extra strength Tylenol or similar agent.
  4. DO NOT USE ANY ASPIRIN or ASPIRIN containing medication. DO NOT use ADVIL or similar medication. These interfere with the clotting mechanism.
  5. You may take Celebrex if your general physician finds that it does not interfere with your OTHER MEDICATIONS.
Please consult the following information documents for a more thorough review of post-operative instructions:

Post-operative Cervical Spine Surgery Instructions

Post-operative Lumbar Spine Surgery Instructions



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This page last edited on 2/19

All content ©2016 by Neurosurgical Consultants, P.A.
Author, Martin L. Lazar, MD, FACS
All Rights Reserved. See Usage Notices.