Pain Management

Pain management is an essential part of the care of the surgical patient and is something Dr. Rose takes very seriously. We have very effective, multdisciplinary, procedures for proactively managing post-operative pain.  While it is not possible to completely eliminate surgical pain with oral medications, Dr. Rose's goal is to keep surgical pain from causing distress. Examples of the goals for pain relief include allowing for four to six hours of uninterrupted sleep and maintaining a pain level below approximately 3 out of a scale of 10 when awake.

1.  Dr. Rose provides prescriptions for only the following post operative pain medicines:
  •         Norco which consists of hydrocodone and acetaminophen, or
  •         Tylenol #3 which contains codeine and acetaminophen
These medications are sufficient for pain control in the vast majority of surgical patients, especially when supplemented with ibuprofen or naproxen.  Should these medications not be adequate, additional options are noted below.

2.  If you are prone to nausea with pain medication, please ask in advance for a nausea medication. Dr. Rose will provide prescriptions for either phenergan or ondansetron (Zofran), both of which are effective nausea medications.

3.  Prior to surgery, if you feel you are in need of stronger medication, Dr. Rose will arrange for an outpatient consultation with a pain management physician. Should you choose this option, the pain management physician will determine what medications are indicated and provide prescriptions. The pain management physician will assume responsibility for all future pain medication prescriptions and you will be required to follow that physician’s policies.  If another physician is providing you with pain medication, Dr. Rose will not provide controlled substance prescriptions.

4.  Many surgeries can be performed with long acting local anesthetic or nerve blocks that will last 12-18 hours. These are a very useful way to minimize anesthetic mediations and reduce side effects associated with surgery and pain medicine.  Unfortunately, the numbing effect usually wears off in the middle of the night after surgery and it can be quite painful if patients have not already been taking pain medication. Therefore, on the night of surgery, you should take the recommended dose of your pain medication every six hours until the numbness wears off.

5.  Except as noted above, pain medication is to be taken on an "as needed" basis as directed on the bottle. Do not take pain medication at specific intervals if you are not in pain. Your pain level will drop over the few days after surgery and you should reduce the number of pills dose and increase the interval at which you are taking medications accordingly. You can even cut the narcotic pills in half to further reduce the side effects.

6.  Do not take more than the prescribed amount of your medication. These medications contain acetaminophen, an excess of which can cause liver failure and/or death. MORE THAN TWELVE NORCO OR EIGHT TYLENOL #3 IN 24 HOURS IS UNSAFE.

7.  Should a pain medication refill be needed, patients must contact our office directly. Phone calls from family members for narcotic refills are not permitted as we need to assess the patient directly.  For similar reasons, pharmacy requests for narcotic refills will also be denied. Please anticipate the need for refills and call at least one business day before running out of medication.

8.  If your pain control after surgery is not adequate, there are a few options. It is safe to take ibuprofen (Advil) or naproxen (Alleve) in addition to Norco or Tylenol #3. Follow the instructions on the bottle. DO NOT TAKE ADDITIONAL ACETAMINOPHEN DUE TO RISK OF LIVER FAILURE AND DEATH. You can elevate the affected extremity and you may loosen the ace wrap around your dressing to see if this helps. Please do not remove the entire dressing. If the above actions do not help or you are in extreme pain, please call Dr. Rose immediately.