Dr. Peter McEwen - M.B.B.S. F.R.A.C.S(Ortho).F.A.Ortho.A.DipModLang - Surgery Knee Dr. Peter McEwen - Surgery Knee: (123) 456789
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Patient Info

Pain Relief Patient Guide

Adequate pain relief following surgery is very important to allow you to sleep, exercise appropriately and generally recover from your operation as comfortably as possible. This is a generic guide and you may have been given a regime that differs.

Pain relief medication is much more effective when used in a pre-emptive manner, that is, used regularly to control pain, rather than waiting for pain to get worse.  Keep in mind that oral medications do take time to act after being ingested.

Many of the drugs used to control pain cause various side effects and it is important to recognize these and deal with them quickly (see section about side effects).

If you have any queries regarding appropriate use of your pain medications please contact the rooms (contact details are on the back of this brochure).

Anything that distracts your attention from a source of pain will also help manage your pain. This can be as simple as having your mind actively engaged in another task. Music, television, reading or anything that takes your mind off your pain, will assist you. This will be much more challenging at night and without fail, night pain will persist for much longer after surgery. For most patients it will be necessary to continue pain relief longer at night even though daytime pain relief is not required.

Everyone experiences pain differently. There is absolutely no point in comparing your experience to someone else's. There is no set time frame for the use of pain relief medication and the length needs to be tailored to your own response.

Ice Therapy

Ice therapy will assist greatly with pain relief, particularly in the context of major knee surgery. Cryocuff is a critical part of the pain relief in recovery protocol and should be used as much as possible in the first postoperative week.

Medications

Ensure you have the marked medications when leaving the hospital:

  • Paracetamol
  • Anti-Inflammatory – ibuprofen, meloxicam, celebrex (if prescribed)
  • Temazepam— fill script
  • Endone (you will also have a repeat script in your discharge envelope)
  • Lactulose - fill script/take home existing
  • Cartia (aspirin)

Paracetamol 500mg (panadol, panamax)

Of all the pain relief medications Paracetamol is the least likely to cause side effects and is therefore the first that should be used and the last to be discontinued. Paracetamol by itself is not a strong pain reliever for surgical grade pain but it does significantly reduce the amount of narcotic pain relief required.

Anti-Inflammatory

  • Meloxicam
  • Celebrex
  • Ibuprofen

These medications must be taken on a full stomach and should not be taken with gastric irritants, such as coffee, alcohol and soft drinks. Please ensure you drink enough fluids, as they are removed through the kidneys.

If you have not been instructed to take an anti-inflammatory, please check before taking, (this includes Nurofen).

If you are also prescribed aspirin, please do not take it at the same meal as an anti-inflammatory as it is a similar drug. For example, take the aspirin with lunch and the anti-inflammatory with breakfast.

Narcotic Pain Relief (Endone 5mg)

Endone is to be used as a PRN (as required) medication.  It is a strong narcotic and like all drugs in this class can cause a myriad of side effects including nausea, constipation, hallucinations and strange dreams, mood alteration and any other side effect one cares to mention.  Generally, the less narcotic that is required the less likely one is to have side effects.  The Paracetamol, anti-inflammatories and Ice therapy all dramatically reduce the amount of narcotic that is required and therefore the side effects.  In most circumstances the Endone is best used at night but it can be used during the day in the early period after surgery.  It is very important to take note that Endone is a very strong drug and should be kept out of reach of children as the drug is potentially strong enough to cause a respiratory arrest in a small child.  Any Endone that is left over following the completion of your treatment should be handed back to a pharmacist for disposal.  Never operate a vehicle or drive whilst taking Endone as this is akin to driving under the influence.

Sleeping Tablet (Temazepam 10mg)

Temazepam is a reasonably mild sleeping tablet that wears off after a few hours and unlike stronger painkillers will not leave one feeling hung over the next day.  By itself, Temazepam is not strong enough to guarantee a nights sleep when dealing with early postoperative pain but if taken in combination with an Endone tablet does tend to work well.  The combination results in the use of less Endone and therefore fewer side effects.  In most cases the appropriate way to use Endone and Temazepam at night is to take one of each tablet an hour before bedtime.  It is completely reasonable to do exactly the same thing again if you wake in the middle of the night and cannot go back to sleep.

Dr. Peter McEwen - Surgery of Knee
Dr. Peter McEwen - Surgery of Knee
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Australian Orthopaedic Association Royal Australasian College of Surgeons
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Crocodiles Orthopaedic Research Institute of Queensland
 

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