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)