Pain relief after bone and joint surgery, and your first two weeks at home

In short: pain relief after bone and joint surgery usually combines several approaches, such as a nerve block, regular non-opioid medicines, ice and movement, with a short course of an opioid if needed. Before you go home you should have a written plan that says what to take, how to reduce and stop any opioid, and who to call. Constipation, drowsiness and nausea are common with opioids. Do not drive or drink alcohol while taking them, and take leftovers back to a pharmacy.

The aim: comfortable enough to move

Moving early matters after orthopaedic surgery. Australia’s hip fracture standard, for example, aims for people to be up and moving on the day of surgery or the day after. Pain that stops you getting out of bed, doing your exercises or sleeping is pain that needs better treatment. So your team will ask not only how much it hurts, but also what the pain is stopping you from doing.

Several approaches, used together

The Australian Commission on Safety and Quality in Health Care’s opioid standard describes the options your team should explain, with their benefits and harms:

• Non-medicine approaches, such as ice packs or heat packs, exercise and physiotherapy.
• Non-opioid medicines, such as paracetamol and anti-inflammatory medicines, used on their own or alongside a smaller dose of opioid.
• Local anaesthetic and nerve blocks, which numb the area for hours after the operation. The hip fracture standard notes that nerve blocks reduce the amount of opioid needed, and with it side effects such as drowsiness and confusion.
• Opioid medicines, when other medicines are not enough or are not suitable.

Using several approaches at once means each can do part of the work, so less of the strongest medicines is needed.

In hospital

• You will be asked about your pain regularly, along with how well you can move. Tell the staff honestly, including at night.
• Medicines are adjusted as you improve. The opioid standard expects doses to come down as recovery progresses, and medicines given through a drip to be swapped for tablets when possible.
• Staff watch for side effects. Constipation, nausea, itch and drowsiness are common with opioids. Laxatives are usually prescribed to prevent constipation. If you become very drowsy, you should not have more opioid until you are fully awake.
• As a nerve block or spinal wears off, the pain of the operation can return. Ask for pain relief when discomfort starts, not when it has become severe.

Opioids: short, planned and then stopped

Opioid medicines are useful for strong pain in the first days after surgery. Australia’s opioid standard aims to keep their use short and planned, and sets out what you should expect:

• The lowest dose that works, for a short time. For people new to opioids, short-acting forms are preferred. Slow-release (modified-release) opioids should be the exception, not the routine, for pain after surgery.
• A limited supply when you leave. After a hospital stay, the standard says the most that can be supplied is seven days of treatment, based on how much you needed in your last 24 hours in hospital.
• A plan to reduce and stop. You should receive a written plan explaining why the opioid was prescribed, how to cut down and stop, and how to store and dispose of it. Your GP should receive a copy.
• A GP visit soon after you leave, so your pain and medicines can be reviewed.

Your first two weeks at home

Every operation and every person is different, so use this as a guide to the questions to ask, not a timetable. Your surgeon’s and physiotherapist’s instructions come first.

1. Leaving hospital

   Check that you have a written plan covering your medicines, any clot prevention, your exercises, wound care, follow-up appointments and who to call. Make sure you understand when each medicine is due.

2. The first few days

   Take your regular pain relief as prescribed rather than waiting for pain to build. Use ice or elevation if your surgeon or physiotherapist recommends them. Expect to feel tired, and expect sleep to be disturbed for a while.

   If you are taking an opioid, take the laxative you were given to prevent constipation. Drink fluids unless you have been told to limit them, and keep moving as advised.

3. The first week

   Keep up your exercises; they matter for both the joint and the prevention of blood clots. If pain is stopping you from doing them, contact your surgeon's rooms or GP rather than pushing through or giving up.

4. The second week

   Follow your plan for reducing and stopping the opioid. Many people find they need less pain relief as the days go on. See your GP as planned, and return unused opioid tablets to a pharmacy once you have stopped.

Common problems and what helps

When to get help

Call 000 if someone cannot be woken, is breathing very slowly, or has chest pain or sudden shortness of breath.

Get advice the same day from your surgeon’s rooms, the hospital or your GP if:

• pain is not controlled by the medicines you have been given
• the wound becomes red, hot, swollen or oozes, or you have a fever
• your calf or leg becomes painful or swollen (see blood clots)
• an older person becomes newly confused, drowsy or agitated (see delirium).

For health advice at any time, healthdirect is on 1800 022 222.

In an emergency, call 000. This information is general and does not replace advice from your treating practitioner.