Effective pain relief is extremely important to patients having surgery. When postoperative pain is controlled, most patients will have an easier recovery and an earlier discharge from hospital. For patients undergoing certain types of surgery, effective early postoperative pain control can also result in less persistence of pain down the road.
Regional Anesthesia and Acute Pain Service Team
Our Regional Anesthesia and Acute Pain Service (or RAAPS team) is dedicated to safely reducing postoperative pain and discomfort while minimizing side effects. In southeastern Wisconsin, the team leads other healthcare facilities in managing acute postoperative pain. Many patients who receive care for orthopaedic problems, who are battling cancer or who have suffered traumatic injuries receive pain relief services from the RAAPS team.
RAAPS team members are available 24 hours a day to address the postoperative or acute pain relief needs of inpatients. Pain relief is tailored to each patient, taking into account the patient’s level and location of pain, medication tolerance, allergies and other factors. Team members are always mindful of patient safety, the efficacy of chosen pain relief methods and potential side effects.
To arrange for RAAPS team services as part of your post-operative care, please discuss this option with your surgeon or admitting physician, who can request a consultation.
Pain Relief for Many Type of Surgeries
Patients undergoing certain surgeries benefit greatly from RAAPS team involvement in postoperative pain management. These include patients having joint replacement and other types of orthopaedic surgery, mastectomy with lymph node dissection, amputations, plastic surgery, abdominal surgery (including surgery for hernia repair, inflammatory bowel disease, or pancreatic, prostate, kidney or bladder cancer), surgery for advanced vascular disease, and trauma patients.
Types of Pain Relief
Team members attack pain from all angles, using a variety of pain relief methods, including oral or intravenous medications and regional nerve blocks.
Oral or Intravenous Medications
Oral or intravenous medications ranging from acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDS) to anti-seizure medications (for treating “burning” or “electric” nerve pain) to opiates (medications originally derived from the opium poppy) are all effective for treating pain. When a greater variety of different methods for treating pain are used (instead of relying on higher doses of only one class of drugs), the outcome for the patient is typically better pain control with reduced side effects.
Regional (local) Nerve Blocks
Regional (local) nerve blocks involve the injection of local anesthetic onto or near nerves for temporary control of pain. A group of nerves, called a plexus or ganglion, that receives pain signals from a specific organ or body region can be blocked with the injection of medication into a specific body area. Patients receiving a nerve block are often given sedation in advance since this sort of pain relief is an invasive procedure, requiring the insertion of a needle near the nerve.
Blocks can be provided before as well as after surgery. A block given before surgery may reduce the amount of general anesthetic needed and help minimize side effects after surgery, including nausea and vomiting.
Patients interested in a nerve block as part of their surgical care should discuss this option with their surgeon before the date of surgery so that the surgeon may request a consult with the RAAPS team.
Different types of nerve blocks are used to target specific areas of the body:
Hip or Thigh: Lumbar plexus nerve block
Froedtert & the Medical College of Wisconsin are unique in the state in offering this type of nerve block, the only peripheral nerve block with significant benefit in alleviating pain in the immediate postoperative period after hip surgery. An alternative method would be to employ an epidural nerve block. However, not only would an epidural numb the non-operative leg and require a bladder catheter, but it could put patients who are on blood thinners at risk of bleeding into the epidural space. As patients receiving a hip replacement are routinely placed on blood thinners after surgery, the use of a lumbar plexus nerve block alleviates much of this concern and does not require a bladder catheter to remain in place.
Knee or Thigh: Femoral nerve block/sciatic nerve block
Froedtert & the Medical College of Wisconsin are unique in southeastern Wisconsin in offering both of these peripheral nerve blocks to most patients for pain relief after knee replacement surgery. The blocks numb both the front (femoral) and back (sciatic) of the knee, reducing postoperative pain while sparing the strength of the other extremity. Having strength in the non-operative leg offers patients much greater mobility after surgery compared to those receiving an epidural. (At other healthcare institutions, patients are typically only offered a femoral nerve block and often have pain in the back of the knee.)
Foot and Ankle: Popliteal or ankle block
By injecting medication near the peripheral nerves behind the knee or at the ankle, just the operative foot can be numbed during surgery. This can leave the other extremities intact for patient function after surgery. The use of a nerve block is the best method of treating bone pain and minimizes the side effects of other medications, such as nausea and vomiting after receiving opioids.
Shoulder: Interscalene nerve block
This typically superficial nerve block in the side of the neck can be extremely effective in treating pain after shoulder surgery, up to and including total shoulder replacements. The neck is a nerve-rich area, and local anesthesia can temporarily numb the voice box, one of the breathing muscles or the eyelid in addition to the shoulder. However, side effects to this nerve block are typically short-lived and well worth the pain relief afforded to patients undergoing shoulder surgery.
Arm or Hand: Brachial plexus blocks
A variety of approaches (supraclavicular, infraclavicular, axillary, elbow or wrist blocks) can be used to numb the operative arm and hand. By placing local anesthesia around the nerves going to the operative arm or hand, only that extremity can be numbed for pain control. This can leave the other extremities intact for patient function after surgery. The use of a nerve block is the best method of treating bony pain, and minimizes the side effects of other medications, such as nausea and vomiting after receiving opioids.
Breast: Paravertebral nerve block
Froedtert & the Medical College of Wisconsin are one of only a few healthcare facilities in Wisconsin offering this type of nerve block for patients having breast and abdominal surgery. A paravertebral nerve block involves injecting local anesthetic into spaces off to the side of the vertebrae and behind the ribs. This is the one of the most effective types of nerve blocks possible and does not involve placing a needle into the epidural or spinal space. Benefits of using this block (versus epidural anesthesia) include better blood pressure control, a lack of itching from epidural drugs and a decreased incidence of arm weakness or numbness during infusion.
Abdomen and Chest: Thoracic epidural
Epidural anesthesia is commonly placed in the upper to mid back for surgeries on the abdomen, similar in many respects to the approach in the low back for women in labor. This technique may also be used for surgery in the area of the chest or breast.
Patient-Controlled Pain Relief
For most nerve blocks and epidurals, patients are able to control how much pain relief they receive. The pain medication is delivered into the body by a pump attached to the nerve block catheter or epidural catheter. If the patient is in pain, he or she can press a button to deliver an extra dose of medication from the pump. The pump is safety-programmed to prevent too much medication from being released. Patient-controlled pain administration often eliminates the need to call a nurse if pain worsens or if the patient is anticipating an increase in pain, such as can occur with physical therapy.
Meet the members of Regional Anesthesia and Acute Pain Services.
Karin Madsen Drescher, MD
RAAPS Division Chief
Christopher Anderson, MD
Craig Cummings, MD
Christopher Fadumiye, MD
Christina Spofford, MD, PhD
Krystal Weierstahl, DO
Rachel Eberle, APNP
Jill Wallers, APNP