Pain Control & Blood Clots

Pain Control

Your nurse may teach you how to use the pain scale below or a similar scale to describe your level of pain after your surgery. In its simplest form, “0” is no pain and “10” is the worst possible pain.

Source: From Hockenberry MJ, Wison D, Wilkelstein ML: Wong's Essentials of Pediatric Nursing, ed 7, St. Louis, 2005, p.1259. Used with permission. Copyright, Mosby.

Our goal is to keep your pain at “3-4” or below.

Pills
If your pain isn’t too severe, taking pills (oral medication) every few hours may be enough to control your pain. Your doctor will prescribe a drug and a dose based on your overall health and level of pain.

You will likely use a combination of pills to control your pain after surgery.

Injections
You may be given a dose of pain-relieving medication by needle (injection), which goes directly into the muscle of your arm, leg or buttock. It could take as long as one hour before you feel the pain-relieving effect.

It is very important to get into a schedule of taking your pain medications one hour before doing your exercises.

Patient controlled analgesia (PCA) pump
If you have had a general anesthetic, you may also have a self-controlled analgesia (PCA) pump. This pump allows you to give yourself a controlled amount of pain medication through your IV tube when you push a button.

Pain, Pain, Go Away!
No two people are exactly alike when it comes to pain. Some people can withstand pain with ease, while others are much more sensitive to pain. You will experience some pain when your operation is over, but there are several ways to control it.

NOTE: It is NOT a good idea to "tough it out" after surgery and refuse medications to ease your pain.

Ask your nurse for pain medication.
Research shows that patients who ask for and receive pain medication actually do better during their rehabilitation. That's because if you are in pain, it may be harder for your therapist to help you get moving. Pain can also make you feel nervous or upset and make you afraid to do the exercises you need to recover. It is important to ask for medications when you are in pain.

Side Effects
Some side effects of pain medicine can include: nausea, vomiting, drowsiness, itchiness and/or constipation. Make sure to tell your nurse if you have any of these symptoms.

About constipation
After surgery, many patients develop symptoms of constipation that can make them feel very uncomfortable. One reason for this is that many painkillers cause constipation as a side effect. Being inactive can also lead to constipation. If you have trouble moving your bowels after surgery, tell your nurse – they can help you!

Preventing Blood clots

A small number of people get blood clots after their surgery. Blood clots usually develop in the deep veins in the legs. People who are inactive or have problems with their circulation are more likely to develop a blood clot.

In some cases, a blood clot can travel from your leg to your lungs. This is known as “pulmonary embolism.” This is a rare event, but it’s good to know the signs and to understand that this is a medical emergency.

A Pulmonary Embolism can happen when blood clots from the deep veins in the legs or pelvis break off, travel up to the lung and get stuck there. If the clot is large enough, it can cut off the blow flow to the lungs. This is a very serious complication.

The doctor will give you blood thinners (called “anticoagulants”) after surgery to stop blood clots from forming. Ankle pumping exercises and early activity will also help prevent this complication. Here are some signs and symptoms of pulmonary embolism:

• Cough (that you didn’t have before surgery)
• Extreme shortness of breath
• Wheezing (that you didn’t have before surgery)
• Blood in your spit
• Fever
• Extreme sweating (while you’re resting)
• Confusion (that you didn’t have before surgery)
• Extreme pain when taking deep breaths

This condition can be life-threatening. If you are in the hospital, tell our nurse or doctor right away if you experience any of these signs or symptoms. If you are at home, call 911.

Blood clots can also develop in the deep veins of your legs in a condition called Deep Vein Thrombosis (DVT). These usually happen because of a lack of movement, so make sure to get out of bed and be as active as possible after your surgery.

It is important to move your ankles up and down several times every hour after surgery. This is called “ankle pumping”. You should also tighten and release the muscles in your legs. These exercises will help your blood flow.

Blood thinning medication (anticoagulants) will also be used to prevent blood clots. They are given in either a pill or needle form. The signs and symptoms of Deep Vein Thrombosis are:

• Increased pain, swelling or tenderness in the calf or thigh of either leg – not just your surgical leg, or in the groin area.
• Lower leg may become hot and red.

This condition requires medical attention. If you are in the hospital, tell our nurse or doctor if you experience any of these signs or symptoms. If you are at home, seek medical attention.

Blood Thinning Medications

You may be given blood thinner medication in needle or pills after your surgery, while you are in the hospital and after you return home. This medication helps stop blood clots from forming in your legs. Your doctor will decide if this medication is right for you.

Blood thinners are usually injected into the skin on your stomach using a very thin, short needle attached to a pre-filled syringe.  

Injections are usually given every day for 10 to 35 days after your surgery. Your nurse may give you injections while you are in hospital. They will also teach you how to do it yourself before you return home.

If you don’t feel comfortable giving yourself the injection, you will need to get a family member or friend to come to the hospital to learn how to give the injection at the same time each day.

To keep healthy circulation and blood flow, you need to keep moving. Walk short distances at least once an hour (except when you are sleeping). When you are sitting or in bed, pump your ankles and flex (tighten and relax) your leg muscles.