Anesthesiology Department Home

The Acute Pain Service

Except in extraordinary cases, some level of pain often follows orthopedic surgery. Because of the severity of orthopedic postoperative pain, surgeons at HSS often consult the Acute Pain Service (APS) to assist with pain management.

The Acute Pain Service at HSS is committed to reducing postoperative pain and assisting with the early phases of rehabilitation from orthopedic surgery. Our goal is to provide effective and safe pain management for all of our surgical patients. Patients with special needs, like those who are currently taking a lot of pain relievers or those who have known sensitivities to certain pain relievers, should be sure to inform their surgeon and the pain management team before surgery.

The APS consists of a specialized team of clinicians with expertise in postoperative pain control, including an anesthesiologist, a nurse with special training in pain management, a pharmacist, and a physical therapist. Physicians from the Musculoskeletal and Interventional Pain Management Division  may be consulted as well, should the need arise.

Patients will receive state-of-the-art postoperative pain control from the APS both in terms of analgesic agents or “pain relievers” and in the techniques used to administrate them.

The APS at HSS typically employs a multi-modal regimen to control postoperative pain. This means that several different types of pain relievers are used to help reduce pain by different mechanisms. This helps to limit the side effects of high doses of one "pain reliever" while reaping the benefits of complimentary analgesia from each technique.

Epidural analgesia, nerve blocks, continuous nerve blocks, local anesthetics, opioids, anti-inflammatory drugs, and ice therapy are among the modes of painkillers currently employed at HSS. The use of alternative therapies like deep breathing exercises is encouraged as well.

Most of our patients will be able to use an analgesic technique referred to as Patient Controlled Analgesia (PCA).

This technique allows patients to customize the delivery of their pain medication whether by intravenous, epidural, or continuous nerve block routes. Patients have the ability to give themselves small doses of pain medication on a frequent, as-needed basis. This flexibility is important, as every patient has different individual needs.

The APS will set limits and controls to help avoid side effects. Extra doses can be given to control pain during peaks of discomfort which may occur during physical therapy. This method of pain management has been associated with higher levels of patient satisfaction, better pain control, and fewer side effects. Nonetheless, you may still experience side effects including nausea, itching, sleepiness, and numbness.

The APS has designed special postoperative analgesia programs for patients undergoing total hip and knee replacement. You can read more about these programs, which are designed to maximize comfort with rapid recovery of mobility, below.

Patients are transitioned to oral pain relievers, usually beginning on the first or second day after surgery, in anticipation of discharge. An anesthesiologist and a nurse on the APS visit every patient on the service once or twice per day. If questions, concerns, or problems arise, a physician from the team is in-house 24-7.

Pain Management for Patients Having a Total Hip Replacement:

Just prior to surgery, your anesthesiologist will place an epidural catheter (small tube by the spine) to be used for postoperative epidural analgesia.

The epidural catheter allows a combination of local anesthetic and opioid to be delivered locally to the spinal cord, thus providing excellent pain relief while limiting side effects to the brain and body. The epidural analgesia will be controlled by you with a PCA device that gives a small continuous infusion in addition to the self-administered doses.

On the morning after surgery, the continuous infusion will be stopped but the self-administered doses will still be available. Oral pain medications will be started that include an opioid, an anti-inflammatory, and acetaminophen. This regimen will typically allow complete transition to oral pain medications by the same afternoon. The epidural can then be discontinued. It is important that the patient communicate with the staff as to how well the plan is working so that adjustments can be made as needed.

Learn more about what to expect by reading Your Total Hip Replacement at HSS: What to Expect.

Pain Management for Patients Having a Total Knee Replacement:

Just prior to surgery, your anesthesiologist will place an epidural catheter (small tube by the spine) to be used for postoperative epidural analgesia.

The epidural catheter allows a combination of local anesthetic and opioid to be delivered locally to the spinal cord, thus providing excellent pain relief while limiting side effects to the brain and body. The epidural analgesia will be controlled by you with a PCA device that gives a small continuous infusion in addition to the self-administered doses.

In addition, a nerve block will be performed to partially “numb up” your knee. This nerve block will typically last overnight and will help control pain during the first, and usually most painful, night. On the morning after surgery, the continuous infusion will be decreased but the self-administered doses will still be available. Oral pain medications will be started that include an opioid, an anti-inflammatory, and acetaminophen.

On the second morning after surgery, the continuous epidural infusion will be stopped but the self-administered doses will still be available. Typically, the epidural can be discontinued on the afternoon of the second day after surgery. This regimen will allow complete transition to oral pain medications by that same evening.

Learn more about what to expect Your Total Knee Replacement at HSS: What to Expect.Musculoskeletal and Interventional Pain Management

^ Back to Top
Request an Appointment