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Pain Management After Hip Replacement

How Painful is Hip Replacement Surgery?
 
No surgery is painless, and hip replacement surgery is no exception.  However, postoperative pain from hip replacement surgery is very manageable.  Despite their surgical pain, it is not unusual for patients to relate how much relief they quickly notice from their preoperative arthritic pain.  While the experience of pain is unique to each individual, most patients manage the immediate postoperative pain from hip replacement without difficulty.

How will my pain be managed?

Most patients getting hip replacement surgery undergo spinal anesthesia.  This type of anesthesia has many benefits, not the least of which is the continuation of pain relief for several hours after surgery.   Additionally, spinal anesthesia has been demonstrated in studies to have other benefits such as decreased surgical blood loss and a decreased risk of the development of lower extremity blood clots when compared with general anesthesia.  While spinal anesthesia can provide the main anesthesia for hip replacement, patients are still sedated so that they are not aware of the surgery as it is occurring.  The muscle relaxation provided by spinal anesthesia also makes performing the surgery easier and therefore less traumatic for the patient.

After surgery, patients are treated with other pain medicine, either by mouth or intravenously.  While it may seem surprising, often the postoperative pain from hip replacement can be managed with just oral pain medicine.  This spares the patient from the side effects of often stronger intravenous medicine.  If it is felt that intravenous medicine is needed, patients are usually provided with a form of patient-controlled analgesia (PCA).  The administration of this type of pain relief is controlled by the patient.  The patient presses a button which releases a set amount of pain medicine intravenously.  This allows the patient to get pain medicine on a timely basis without, for example, waiting for a nurse to administer the medication.  Patients generally do not have to worry about taking too much medicine, because there is a set limit of medicine that can be delivered this way.  These types of pain control are generally provided until the day after surgery.  After this, most pain medicine is provided in pill form as needed.

How long will I have pain after surgery?

It is difficult to give a specific answer for this, but most patients notice good pain relief within the first week after surgery.  Surgical pain is usually at its worst for the first 24 to 48 hours after surgery.  After this, patients are usually more comfortable.  They may experience some increased pain when doing exercises or therapy, but this can be easily managed by timing the administration of pain medicine to coincide with therapy.

What can I do to help manage my pain?

The most important thing that patients can do is to let their treatment team know about the pain they are experiencing.  This is usually expressed on a scale of 1 (little or no pain) to 10 (severe pain).  This information helps the healthcare team to provide the right type and amount of pain medication.  Patients can also help relieve their pain with means other than pain medicine.  For example, applying ice and elevation to the hip area after therapy can go a long way toward controlling the swelling that often causes discomfort after such activity.  On the other hand, when patients have discomfort from stiffness, usually doing some exercises will help relieve this pain more than any medicine will.

Is it OK to take pain medicine?

Some patients almost have a fear of taking pain medicine.  Some patients think that they will quickly become addicted to narcotic medication.  This is simply not true.  Postoperatively, patients have a good reason to have pain and this is appropriately treated with pain medicine.  It often takes less narcotic to control a person’s pain when the medicine is taken appropriately – that is, when the patient begins to experience real discomfort.  In the early postoperative period, patients should not try to “hold off” on taking pain medicine because they think the pain will calm down in time.  These patients who “hold off” until their pain becomes too severe often eventually need more narcotic to control their pain than they otherwise would have needed if they had taken their pain medicine earlier.

What are the side effects of pain medicine?

Side effects of pain medicine and anesthesia include nausea, constipation, and sometimes a tired feeling.  Having these side effects does not mean that a patient is allergic to the medication.  If a patient has a problem with these side effects, often the medication can be adjusted or a different medication tried in order to minimize these effects.