In most instances, your surgeon will order any needed post-operative pain medication. However, when significant pain might slow recovery, such as after chest, major abdominal or major bone operations, we may be asked by your surgeon to perform certain special procedures. These techniques include spinal, epidural and nerve blocks.

If your surgeon has requested one of these techniques, your anesthesiologist will discuss the procedure with you including the expected benefits and risks.

It is important to keep in mind that no technique, procedure or medicine is capable of totally eliminating all post-operative pain or discomfort. Our goal is to combine medicines and procedures in order to make you as comfortable as possible and facilitate your recovery from surgery.

Before beginning your anesthetic, a small area of your lower back is numbed with local anesthesia. A small needle is passed through the numb area into the spinal fluid. A narcotic, usually morphine, is then injected and the needle is removed.

Using this technique can provide long lasting (18-24 hours) post-operative pain relief. The pain relief is often better than that of intravenous (IV) or intramuscular (IM) narcotic injections and usually causes less sleepiness and other side effects.

Special monitoring is required in the post-operative period but this can be done on the surgical floors.

Epidural pain management also begins before your regular anesthetic. After numbing the skin, a very small plastic tube, or catheter, is inserted through an needle in your back. The tip of this tube is in the epidural space just outside the sack containing the spinal fluid and nerves. Epidurals can be placed in either the upper or lower back depending on the area of your operation.

The epidural catheter is attached to a battery powered pump which continuously administers local anesthesia, sometimes mixed with narcotics. This produces a band of numbness in the area of the surgical procedure which can markedly reduce post-operative pain. In addition to pain relief, this allows the patient to move, breathe and cough more effectively.

The epidural catheter can be left in place for up to 3 days after the operation. As with spinal narcotics, special monitoring is required while the catheter is in place.

Prior to starting your regular anesthetic, the skin will be numbed and light sedation is administered. A needle attached to a battery powered nerve stimulator is then inserted toward the nerve bundles controlling pain sensation from your arms or legs. When the needle is near the appropriate nerve, muscle movement is seen in the desired area.

Local anesthesia is then injected through the needle or a catheter is placed for post-operative injection. This will produce pain relief in the operative area. Depending on circumstances, pain relief can be continued for 2 or 3 days post-operatively.

For surgery of the arm, the needle or catheter is usually placed in the neck for shoulder surgery, or in the chest or armpit for arm or hand surgery.

For surgery of the leg, the needle or catheter is usually placed in the groin, buttocks or behind the knee.

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