Preoperative Discussion of Pain Relief

Prepare Patients

"We want you to be as comfortable as possible after your surgery"

"Your body will need time to heal"

"If it feels like something is wrong, you can always check with us"

Make a Plan

"Have you had surgery before? … What did you do for the pain after your last surgery?"

This may reveal a story of problems with pain relief, which ought to give a surgeon pause for discretionary surgery.  When surgery can't be delayed, be prepared to get help: addiction or psychiatry consults; preparation for difficult discussions.  Another red flag: lack of awareness of the opioid epidemic.

  • Postpone discretionary surgery
  • Work with PCP (and any other relevant care providers) on a plan
  • Consider screening for depression, ineffective coping strategies, and propensity for opioid misuse (using the Opioid Risk Tool, or SOAPP)

Most patients will say, "I took a few opioids and then switched to Tylenol or Motrin"

  • Reinforce that.  Emphasize opioids for the first 24-48 hours, perhaps mostly for sleep and then rapid transition to non-opioid pain relievers.
  • Make a plan for pain relief.
  • Determine their preferences for non-opioid pain relievers. Emphasize that one can take Tylenol and NSAIDs simultaneously as they do not cross-react.
  • Worry less about using NSAIDs than opioids.  A recent review shows no clear effect of NSAIDs on bone healing.
  • Discuss which opioid and how much will be given. 
  • Discuss opioid safety
    • "Are you aware of the opioid epidemic?" (lack of awareness may be a red flag—see above)
    • Tell them how to dispose of unused medication (see safety handout)