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Pain Management

Philosophy

Pain control is very important to the overall philosophy of patient care at The Musculoskeletal Tumor Program at Virginia Hospital Center. It has a significant effect on the patient’s well-being and recovery. A carefully executed pain control program not only makes the surgical experience less unpleasant but allows for a quicker and more complete recovery. With the many pharamaceutical and non-pharmaceutical techniques available, both cancer and surgery-related pain can now be well controlled.

Patient-Controlled Analgesia

Patient-controlled analgesia (PCA) is the use of intravenous narcotics, usually morphine, administered with the use of a small pump that is controlled by the patient. The pump has settings that limit the frequency and total dosage that can be self-administered. It is a well-established and very safe method of pain control. The central advantage of PCA is that the patient determines the timing of administration. As a general rule, it is harder to get out of pain than to stay out of pain. When patients have to verbally request pain medication, there is often a delay before administration. This reduces the efficacy of the medication and increases anxiety. Almost all patients who undergo inpatient surgery by Dr. Wodajo will be provided with a PCA pump.

Regional Analgesia

Regional analgesia refers to use of anesthetic agents administered directly onto the nerves that innervate the part of body being operated on. In the lower extremities (hips and knees), this is usually administered with an epidural catheter. This is a well-established technique in common use (such as with childbirth) in which a catheter is inserted into the patient’s back, in between the vertebrae, to bathe the spinal canal with anesthetic agents. It is a very effective form of pain relief. Many patients undergoing bone procedures will have an epidural placed before surgery. The catheter is usually left in place to provide pain relief for the first few days after surgery. It does, however, limit the amount the patient can ambulate, so after a few days the catheter is removed and physical therapy is begun. In the upper extremity (shoulder, arms), an interscalene block is utilized. This is a technique where a single injection of anesthetic is given before surgery into the triangle between the neck and shoulder. A single dose may last up to 18 hours and can make a dramatic difference in post-operative pain.

This is a technique used to apply anesthetic directly onto the nerves suppling the surgical area. It is typicall utilized for major surgeries where extensive dissection of nerves has already been performed as part of the procedure. In this technique, a small catheter is placed alongside the major nerve and continuous infusion of anesthetic initiated after surgery. It is often used in conjunction with regional anesthesia (epidural) and patient controlled analgesia (PCA) and can provide significant, added pain relief with few side-effects.

Ambulatory Pain Pumps

Almost all patients who undergo outpatient surgery by Dr. Wodajo will be provided one of these pumps. The technique allows for a significant reduction in surgical pain and permits the patient to use less oral pain medication. See here for details.

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