What is so bad about surgery?
Pain, Nausea, Vomiting and Going to Sleep
Many times when the topic of surgery comes up, people are more anxious about the pain, nausea and vomiting and anesthesia than they are about the actual procedure. They will say that they are not worried about the surgery, but they dread nausea or are afraid of “going asleep” or of the pain. The good news is that all of these fears can be addressed with some new medicines and techniques. There are even some “low tech and low cost” methods to help in these areas.
Studies show that fear of post operative nausea and vomiting (PONV) is greater than anxiety about pain. The fact is that PONV if uncontrolled can complicate an otherwise successful surgery. It can result in bleeding, increased swelling, bruising, more discomfort, and dehydration. PONV can start a cascade of events which can make the entire surgical recovery a challenge. So what can be done? In the past PONV was treated as an unavoidable part of the whole surgical process. People just had to “tough it out” until they recovered. Now there is an entire area of study to examine new techniques and medicines to stop PONV before it starts. Currently five “pathways” have been identified which lead to PONV. If you are considering surgery, talk with your physician ahead of time to determine your risk for nausea and vomiting after surgery. That risk assessment will determine what steps can be taken to reduce your chances of PONV. You may be at increase risk if you have a sensitive stomach, if you have a history of motion sickness, if you have gotten sick after previous surgeries or if your surgery is scheduled later in the day. What can you do to decrease your chances? Make sure that you are well hydrated the day before your surgery. To reduce the chances of aspiration you will be required to have nothing to eat or drink at least 6 -8 hours prior to your surgery. If your surgery is scheduled for the afternoon, ask you surgeon if you can have something light for breakfast to help with hydration and to prevent hypoglycemia (low blood sugar) which is another cause of PONV. Let your anesthesia provider know if you have had PONV in the past or if you have a history of motion or sea sickness. In that situation, they may place a scopolamine (motion sickness) patch behind your ear. If you know that certain pain medicines make you nauseated then please share that information with your physician and anesthesia provider, so that they can use alternatives. Usually you should take your pain medicine with some food so that it is less likely to upset your stomach. A “low tech” home remedy that can help is to place some rubbing alcohol on cotton ball and to lightly inhale the aroma. Finally, if you should start developing PONV once you get home, let your surgeon know so that they can intervene as able. Remember that no one can completely prevent PONV in all circumstances, but new medicines and methods can help reduce your chances of having to deal with the dreaded “heaves.”
What about fear of “going to sleep?” It is reasonable to have some apprehensions about having a surgery. In large part, our apprehensions are based on fears of the unknown. Often someone had an unpleasant experience in the past, or knows someone who did. Many times people will tell me about some horrible experience a family member had in a surgery twenty years ago. Surgery and anesthesia has changed a lot since then. As surgeons now can work through smaller incisions, anesthesia providers have access to better monitoring equipment and more precise medications. They can make sure that you are really asleep and newer equipment helps reduce the chance of a sore throat after you wake up. Sometimes it helps to speak with others who have recently gone through a similar surgery. They will be able to give you insight about what they did to make their recovery easier. Fears about surgery and anesthesia can often be dispelled by having a clear understanding about what is going to happen and what you can reasonably expect after surgery. It is important that whoever is going to be involved in your post-operative care also has a chance to ask questions so that they can best help you to recovery. If you have done your due diligence in finding a surgeon you trust, have reviewed your expectations and have the support of your friends and family and have prayed through your decision, then you will be physically, mentally and spiritually prepared for your surgical experience and you should find your anxiety level much improved.
Last but not least what about the PAIN? It has often been said “No pain, no gain” and certainly there is bound to be some discomfort after any type of surgery. But as with PONV and anesthesia, newer techniques and medicines, can help with pain so that it is bearable. Avoiding the “pain cycle” is an important step in pain management. To do that, you should not wait until your pain is unbearable to take you pain medicine. Some studies show that it is helpful to take your pain medicine on a scheduled basis during the first 72 hours after surgery as a means of shortening the cycle of discomfort while you heal. Sometimes taking an ibuprofen prior to the onset of intense pain will shorten the overall course of post-operative pain. A newer method of pain control is a pain management pump. It is a slender catheter about the diameter of 3 hairs which is placed in the surgical site and then acts like a soaker hose to bathe the area with some “numbing” medicine similar to that used by dentists. Usually this system alleviates about 50-60% of the discomfort. This in turn reduces the need for narcotic pain medicine which can contribute to PONV, constipation and for some an unpleasant altered mental state.
Prior to your surgery, have a thorough discussion with your surgeon and anesthesia provider regarding your concerns about PONV, anesthesia and pain management. By having a greater understanding about what to expect, and by implementing some of the above steps you can make your surgical experience less intimidating. That way you can reduce your anxiety and focus your energy more positively on speeding your recovery.