Shoulder & Knee Surgeon Perth | Pain relief after surgery

Paracetamol (Panadol) :

Panadol is a very effective and simple painkiller. The usual dose for adults is two tablets (1gm) taken every four to six hours for a maximum of eight tablets per day. Provided the maximum dose is not exceeded, Panadol is an extremely safe painkiller and has virtually no side effects.

The simple painkillers are best taken regularly to build up a therapeutic dose in your bloodstream. Taking two Panadol with each meal and then two tablets before you go to bed is a good routine.

Panadol is also available as Panadol Osteo which is a slightly higher dose and is meant to be taken as two tablets three times per day (not four times per day).
Aspirin is not a recommended painkiller after surgery as it may cause stomach upsets and bleeding.

Anti-inflammatory Drugs:

Despite being called anti-inflammatories, this category of drugs is very good for pain relief. There are many different brands. Over the counter anti-inflammatories include Nurofen and Voltaren. Prescription anti-inflammatories include Naprosyn, Brufen, Feldene, Celebrex and Mobic.

Never take more than one brand of anti-inflammatory as it may lead to overdose.

The commonest side effect of anti-inflammatory drugs is indigestion or reflux. Anti-inflammatories should always be taken with food. Celebrex and Mobic are less likely to cause reflux. Celebrex is probably the commonest anti-inflammatory used for postoperative pain.

Anti-inflammatories do not cause drowsiness. Anti-inflammatories can aggravate high blood pressure. They are generally very safe for short term use (up to thirty days). Long term use should be discussed with your general practitioner.

Most patients will require some form of narcotic analgesic for moderately severe postoperative pain. Here is a list of some of the common narcotic analgesics in use:

Panadeine and Panadeine Forte:

These drugs are a combination of paracetamol (Panadol 500mg) and codeine. Panadeine has approximately 15mg of codeine per tablet and Panadeine Forte has 30mg of codeine per tablet. Codeine is a narcotic analgesic which will provide stronger pain relief.

The usual dose of Panadeine or Panadeine Forte is the same as Panadol, that is one to two tablets every four to six hours up to a maximum of eight tablets per day. You can interchange Panadol, Panadeine or Panadeine Forte in this maximum of eight tablets. For example, you might take Panadol or Panadeine during the day and Panadeine Forte at night.

Codeine is notorious for causing constipation. A diet high in fibre and maintaining good hydration is preventitve, laxatives such as Movicol may be required.

Tramadol (Tramal):

Tramadol is a very commonly used drug for moderately severe postoperative pain relief for moderately severe pain. It comes as 50mg immediate release tablets and the usual dose is one to two tablets every four to six hours. It is also available as a slow release preparation that only needs to be taken twice a day.

Oxycodone (Endone):

Oxycodone is a very strong painkiller and should be reserved for severe postoperative pain. It is commonly prescribed as 5mg tablets and the usual dose is one to two tablets taken as frequently as every two hours for severe pain but usually every four to six hours. Only twenty tablets can be provided on any one prescription.

Targin:

Targin is a slow release version of oxycodone which contains a second drug to reduce the risk of constipation. It has the advantage that it is only required to be taken twice a day and with fewer side effects.

Tapentadol (Palexia):

This is a newer narcotic analgesic which is a useful option for patients who do not respond adequately to more commonly used narcotic analgesics.

Buprenorphine (Temgesic sublingual, Norspan patch):

Buprenorphine comes in two forms. Firstly, it can be used as a tablet placed under the tongue (sublingual). Again, it is used in this form mostly for people who are not tolerating the more common narcotic analgesics such as oxycodone.

It is also available as a Norspan patch which looks something like a large band aid. The drug is absorbed through the skin. This is can be a very effective way to provide base line pain relief for more painful surgical procedures and is particularly advantageous in shoulder surgery. The patch is usually put on at the time of surgery but may take up to twelve hours to start working. The patch usually stays in place for five days. Because the drug is absorbed continuously, it provides very reliable pain relief without the highs and lows associated with taking tablets.

If you experience side effects (nausea) from the patch, then it should be removed. However, it may also take twelve hours for the drug to wear off.

Morphine, Pethadine and Fentanyl:

These are narcotic or opioid drugs which are usually given intravenously through a drip or by intramuscular injection. They are generally only required within the first twenty-four hours of surgery. They may be administered via a PCA (patient controlled analgesia). This device allows you to administer pain relief to yourself with a set maximum dose. A PCA can be a good way to control severe pain in the immediate postoperative period. Unfortunately, because the drugs are so strong, the nurses will need to check your blood pressure regularly overnight which leads to a very interrupted sleep.

Pregabalin (Lyrica):

Specifically targets nerve pain. Major side effects are drowsiness and dizziness.