There are a variety of drugs used to treat pain. Drugs commonly used to treat post-operative pain are narcotics and local anesthetics. The chart below offers an easy way to visualize the effects of these different pain relief options.

Click on the links below for information about pain treatments.

• Pain Relief Medicines (Narcotics)
• Local Anesthetics
• Continuous Nerve Block and Surgical-Site Pain Relief
• Non-Drug Alternative

Post-op pain relief

To understand different types of pain, click here.

Patients' role in pain relief options, click here.

To learn about specific post- surgical pain relief options, click here.

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Narcotics

• What are narcotics?
  • Narcotics include drugs such as morphine, demeral and codeine. These drugs work well in treating severe pain.
    
    
• How are narcotics given?
  • Narcotics may be taken in pill form. They may also be given by a doctor or nurse as an injection into the muscle or through a tube (catheter) placed in your vein (intravenous or IV).
  • Narcotics are usually given every four to six hours. There may be a delay in pain relief since you must ask for the medicine and wait for it to be brought to you. Pain may "break through" before you get your next dose of medicine.
  • Patient Controlled Analgesia (PCA) is another method of getting the medicine into your vein. Instead of waiting for a pain pill or shot, a special pump (PCA pump) lets you control your pain medicine by pressing a button that releases the drug when you begin to feel pain.
    
    
• What are the benefits?
  • In the treatment of severe pain that involves large areas of the body, such as that experienced with cancer, narcotics may be the most appropriate source of relief.
    
    
• What are the risks?
  • Narcotics enter the bloodstream and can have a variety of negative side effects. These effects can interfere with normal activities, slow your recovery, delay your release from the hospital and make you feel really uncomfortable. Some negative narcotic side effects include:

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Local Anesthetics (Regional or Local Anesthesia)

• What are local anesthetics?
  • Local anesthetics are medicines that work directly at the incision site to dull feeling without causing sleepiness or loss of sensation in other body parts. A shot of a local anesthetic is what the dentist may give you when you have a tooth filled. Examples of local anesthetics are novocaine, Lidocaine and Bupivacaine.
    
    
• How are local anesthetics given?
  • They may be given before surgery directly into the nerve that supplies feeling to the area of the surgical procedure. This is called a nerve block. They may also be given directly into the incision during surgery to numb the area. The area stays numb for a few hours after surgery, but pain medicine will be needed after the effects of the local anesthetic wear off. Local anesthetics may also be administered through a small tube in your back (epidural/spinal). This method is commonly used to relieve pain during childbirth. Used in this way, local anesthetics may offer pain relief for two to eight hours before they begin to wear off.
    
    
• What are the benefits?
  • Short-term numbing of the surgical area may allow your surgeon to operate without giving you general anesthesia.
    
    
• What risks are avoided?
  • Local anesthetics may have fewer side effects than narcotics in that the medicine works where it is needed, instead of all over the body. Local anesthetics provide pain relief and generally do not cause nausea, sleepiness, breathing problems or constipation, which are common with narcotics.

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Continuous Nerve Block and Surgical-Site Pain Relief (Local Anesthesia)

• What is a continuous nerve block?
  • The anesthesiologist will block the appropriate nerve(s) near the area of the surgical procedure for regional anesthesia and post-operative pain management. Nerve blocks are primarily done for orthopedic procedures, such as knee and shoulder surgery. After the physician locates the appropriate nerve, a small catheter (tube) is inserted at the site and connects to the ON-Q C-bloc pump which will continuously infuse local anesthetic for up to five days. The physician may choose to use ON-Q C-bloc with ONDEMAND which is a pump that will deliver a continuous infusion and also allow the patient to give an extra dose of medication as needed.
    
    
• What is continuous surgical-site pain relief?
• Continuous surgical-site pain relief involves giving a constant infusion of a local anesthetic medicine directly into the surgical site. You experience pain relief directly at the incision site without the side effects of narcotics. Because the medicine is given continuously at a safe and slow flow rate, you do not have to worry about the medicine wearing off. As a big plus, being comfortable after surgery may actively speed your recovery.
  
  
• How do they work?
  • The ON-Q System, a market leading post-op pain relief system, uses a small balloon-like pump that is filled with a local anesthetic medicine. The pump is attached to a catheter (tiny tube) that the doctor places near your incision site. The system is very easy to use. The pump automatically delivers the medicine at a slow flow rate. The pump may last anywhere from two to five days. The pump is completely portable, lightweight and can be attached to your gown or clothing or placed in a carrying pouch. When the infusion is complete, the catheter is removed and the pump is thrown away. Depending on your surgery, you may go home with one of these pain relief systems.
    
    
• What are the benefits?
  • Benefits of the system over other methods of pain relief include:
    • Direct pain relief without the side effects of narcotics
    • Constant pain relief - reduces intense pain spikes
    • Quicker return to moving around, walking and normal activities
    • Earlier hospital release
      
      
• What are the limitations?
  • The system only supplies supportive (adjunctive) pain relief and may not be 100% effective when used alone. It does not necessarily eliminate all pain.
    
    

Is continuous surgical-site pain relief a better method than others? Benefits of this system over other methods of pain relief are summarized in the table below:

Potential Results	ON-Q System	ON-Q System	Narcotics
	Nerve Block	Surgical Site
Less pain
Continuous pain relief
Regional anesthesia during the surgery
Faster return to normal activities
Quicker return to normal body function
Surgical-site pain relief
Clear and groggy-free head
Quicker ambulation
Greater mobility
More comfortable recovery
Earlier hospital release
Cost savings
Nausea
Vomiting
Sleepiness
Possible breathing problems
Constipation
Groggy, knocked-out, "hangover" feeling
Overall slower recovery
Higher risk for intense pain spikes

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Non-Drug Pain Relief Methods

Other methods may also be used for pain relief after surgery. These methods may be used in combination with drugs. Examples are: Cold therapy, massage, nerve stimulation (TENS) and relaxation techniques.

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References:
AHCPR Pub. No. 92-0021. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department and Human Services. Feb 1992.)