Pain management is usually not a problem for most Brain
Surgery patients. While a "headache" and or incision
pain is common, relatively mild analgesics (pain relieving
medication) are all that is usually required.
In the early post-operative period, particularly
during the stay in the Neurological Intensive Care Unit
(NICU), the nursing staff will be conducting frequent
Neurological examinations. These examinations BEGIN
with an assessment of the LEVEL OF ALERTNESS of the patient.
Narcotic analgesics, while generally having the affect of
lowering the perception of pain, will cause most patients to
become lethargic, stuporous or worse. The nursing
and medical staff is then faced with the dilemma to determine if
the patient has suffered this neurological deterioration consequent
to Brain swelling, an Intracranial Haemorrhage, Hydrocephalus or
Intracranial Infection. The cost in additional Neuroimaging
tests (CT and/or MRI scans), additional attention from the medical
personnel and medications to try to reverse the "deterioration" may
Additionally, a lethargic or stuporous patient will fail to
breathe deeply in a normal fashion resulting in an
increase in the Carbon Dioxide concentration of the blood, the
consequence of which is an increase in the Intracranial Pressure
(ICP). This has the potential for a life threatening
For these reasons we strongly advise patients to choose
carefully when requesting pain relief medication. We do
not wish for anyone to suffer pain needlessly and acknowledge that
one's ability to tolerate pain varies from one individual to
another. Nevertheless, in this unique circumstance, injudicious
use could lead to serious consequences.
Access to appropriate analgesics will be available to all
patients both during their stay in the NICU, Neurosurgical ward
and upon discharge from hospital.
In general, Dr. Lazar recommends that you avoid taking pain
relieving medication in anticipation that something you will do
is going to cause pain. For pain management, try Extra Strength
Tylenol (Acetaminophen). You may be given a prescription for a
drug like Vicodin (hydrocodone) or Darvocet N100. DO NOT USE ANY
ASPIRIN (or ASPIRIN containing medication) or ADVIL (Ibuprophen)
since these medications interfere with the clotting mechanism.
For additional information, please consult our
Post-operative Brain Surgery Instructions.
Pain is a common symptom that accompanies pathological
conditions for which most spine operations are conducted.
The majority of our patients report that the pain of the
operation is less than the pain that brought them to our office
for Neurosurgical Consultation. While this is not a
universal experience, it is the most frequent one. Most other
patients report considerably less pain than the pre-operative
Initial post-operative pain control is achieved in the
hospital's recovery Room (or Post-anesthesia Care Unit- PACU)
where specially trained nurses are at the bedside to monitor
the patient's vital signs as well as administer appropriate
medications for pain control.
Patients will have a "menu" of pain relief medication of
varying strengths to choose from. These extend in potency from
injectable narcotics to intermediate strength oral tablets and to
less powerful medications such as Tylenol. It is important
to make certain that you are not "over-medicated" in the
early post-operative period since the medication may put
you to sleep resulting in a failure to breath deeply, which
is required to reduce the concentration of residual anesthetic
medication that must find its way out of the body before the staff
can mobilize you.
We do not want you to suffer needlessly. On the other hand,
excessive narcotic analgesic use can lead to significant
complications including lung problems.
The following guidelines may be useful to you in managing pain:
Please consult the following information documents for a more
thorough review of post-operative instructions:
- PAIN IS A RED FLAG TELLING YOU TO REST.
- Avoid taking pain relieving medication in anticipation
that something you will do is going to cause pain.
- Medications: For pain management, you will usually be
given a prescription for a drug like Vicodin (hydrocodone)
or Darvocet N100. For additional pain medication, try Extra
strength Tylenol or similar agent.
- DO NOT USE ANY ASPIRIN or ASPIRIN containing
medication. DO NOT use ADVIL or similar medication. These
interfere with the clotting mechanism.
- You may take Celebrex if your general physician finds
that it does not interfere with your OTHER MEDICATIONS.
Post-operative Cervical Spine Surgery Instructions
Post-operative Lumbar Spine Surgery Instructions
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This page last edited on 2/19