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Date issued: May 2023

Review date: May 2025 

Ref: C-533/RV/Anaesthetics/Pain after surgery

PDF:  Pain after surgery final May 2023.pdf[pdf] 162KB

Why do I need painkillers?

Pain after surgery is known as acute pain; it has a known cause and will usually improve as the tissues heal. Pain after surgery is normal.

The purpose of your pain-relieving medicines (painkillers) is to reduce your pain to a level where you can do your normal activities while your body heals.

Taking painkillers regularly after leaving hospital will help you cough, move, walk, and become more active. This is important to help you recover and prevent complications such as stiff joints and muscles, constipation, and blood clots in your legs (Deep Vein Thrombosis).

Types of painkillers

Painkillers come in several forms e.g., capsules, tablets and liquids. Painkillers taken by mouth start to work in about 20-30 minutes. Some should be taken regularly, and others are used only when regular simple pain relief is not enough, and your pain is moderate or severe. You need to be able to eat, drink and not feel sick for these drugs to work.

There are three main types of painkillers:

1. Paracetamol.

2. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):

• Ibuprofen & Naproxen.

3. Opioids:

• Weak opioids: Codeine.

• Intermediate opioids: Tramadol.

• Strong opioids: Morphine oral solution (Oramorph) or oxycodone.

After your surgery you will probably be prescribed more than one type of painkiller. It is safe to take more than one type, provided they come from different categories (1-3 above). In fact, it is best to take combinations of painkiller that work in different ways, this helps to control your pain whilst minimising side effects. For example: ibuprofen every 8 hours and paracetamol every 6 hours. Please stock up on your preferred brand of ‘over the counter’ painkillers (enough for 5 days). Read the contents of over-the-counter painkillers carefully, some contain paracetamol as well as other ingredients.

Paracetamol

Although paracetamol is a common ‘over the counter’ painkiller it works well on post-operative pain if taken regularly. Paracetamol is best taken four times a day. We advise taking paracetamol regularly for at least the first three days after surgery.

Paracetamol can safely be taken alongside other painkillers and can help them work better.

No more than 4 grams of paracetamol should be taken each day. Paracetamol overdose can be very dangerous, so be careful when using over the counter painkillers as well.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Ibuprofen & naproxen belong to a type of drug called NSAIDs and work by reducing inflammation (swelling) and pain after surgery. These drugs should be taken with food to reduce the risk of stomach complications.

Ibuprofen can be taken every 8 hours (approximately 3 times a day).

Naproxen is a longer acting NSAID and is prescribed twice a day; in the morning at breakfast, and before bed in the evening (roughly 12 hours apart).

You may also be prescribed medicine to protect your stomach when taking NSAIDs.

Opioids

Opioid painkillers are taken as needed after some operations when your pain is moderate or severe, in addition to regular paracetamol and/or NSAIDs. For more details on opioids, please see the opioid pain relief patient leaflet.

Codeine is a weak opioid. It works well for some people but not others. It can cause constipation, so regular fluid and fibre intake is important (medicines to prevent constipation may also be prescribed).

Co-codamol is a combination of paracetamol and codeine and is effective for mild to moderate pain.

Tramadol, morphine oral solution (MOS or Oramorph), and oxycodone are “stronger” opioids and may also be prescribed alongside paracetamol and NSAIDs on occasion.

Tramadol is a tablet that is usually taken 4 times a day if your pain is moderate or severe.

Morphine oral solution (MOS) is a liquid form of morphine, also called Oramorph. It acts in 20-30 minutes and can be taken up to six times a day (every 4 hours in appropriate doses) for pain not responding to regular combinations of painkillers. Oramorph should only be used for a day or two and will be prescribed for a maximum of 5 days.

Overdose can be very dangerous, so it is important to follow the prescribed doses carefully and measure liquids carefully.

Do not give these medicines to anyone else or save them for a later date. This may result in serious harm.

Side Effects

There will be an information leaflet from the manufacturer, specific to that medicine, inside each box of painkillers that we provide. This will outline the possible side effects that each medicine may cause. Read these information leaflets alongside the advice provided here.

Nerve blocks

For some types of surgery, you may have received a local anaesthetic “nerve block” from your anaesthetist for pain relief during and after your surgery. This means you may have no pain at all before you leave hospital and this can last from 2-18 hours. Tingling sensations in the operated area are often a sign that the nerve block is wearing off and normal sensations and pain may rapidly return.

It is much easier to treat pain as it starts than to try and catch up if your pain becomes severe. We recommend taking regular Paracetamol and NSAIDs (if prescribed) even whilst you are pain free and your nerve block is still working. This helps build up effective levels of medicine in your body and ensures you are ready for when the local anaesthetic nerve block wears off.

If the block has not fully worn off by 72 hours after the operation you should contact one of the anaesthetists by calling the anaesthetic department.

When do I stop taking painkillers?

After 3-5 days you should be able to reduce your painkillers. It is advisable to reduce or stop the strongest painkillers first, particularly if this is tramadol, morphine or oxycodone. If your pain remains well controlled, then you should be able to continue to reduce your other painkillers over the next few days.

However, if your pain increases when you reduce / stop the painkillers (especially if it stops you gently exercising or doing the advised physiotherapy), then it is best to start that painkiller again. If this happens, you could talk to a pharmacist for advice. Your General Practitioner (GP) or NHS 111 may help if your pain remains severe.

If you have left-over painkillers, particularly opioid drugs, please dispose of them appropriately. They can be returned to your pharmacy for disposal.

Other Points to Remember

• It is important to follow the labels on your medicines, and not to exceed the recommended dose.

• If you are taking cold / flu remedies, these may also contain paracetamol, so please check the label and do not exceed 4 grams of paracetamol in 24 hours. If you think that you have taken more than this (in a single dose or in a 24 hour period), please contact NHS 111. Paracetamol overdose can be very dangerous.

• Some pain relief needs to be taken with food. Read the manufacturers’ instructions for details.

• There are other methods of managing pain and the App / Website http://www.headspace.com gives advice on Mindfulness and coping strategies for pain.

• If you are having difficulty reducing your pain relief medicine, particularly opioids, contact your pharmacist or GP for advice.