The Answer: You have two issues with regard to pain: one immediately after surgery while in hospital and another when you go home. While most surgeons write a prescription for pain medication after surgery, I would advise you to use your appointment with your anesthesiologist to see what can also be done about pain control after you leave hospital. Oftentimes, patients are sent home with a one-size-fits-all pain plan that may work for most but certainly not all. Ideally, you want something more personalized.

“Patients list pain control after surgery as one of their major concerns” said Dr. Colin McCartney, staff anesthesiologist and director of anesthesia research at Sunnybrook Health Sciences Centre. “And some patients are very reluctant to take medications after discharge and would rather suffer pain and limitation of activity instead.”

Severe postoperative pain can cause an increase in blood pressure and heart rate and it may decrease ability to breath deeply and cough leading to greater risk of cardiac problems and chest infection after surgery. And because poor pain control inhibits movement, those with limited mobility are predisposed to other risks such as blood clots, according to Dr. McCartney, who is also a pain specialist.

“There is evidence that those patients who suffer severe pain immediately after surgery are at greater risk of suffering chronic pain months or years afterward,” he said.

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I’ve lost count of the number of times I’ve nearly or completely passed out after getting a needle. First come the sweats, then the black spots, and finally, the floor. I know, how pathetic for a former health reporter and a current hospital employee! After giving birth twice, my tolerance to needles has increased slightly, but it’s game over if they keep jabbing it in trying to find the right spot.

This said, what could I possibly have in common with someone who makes a living giving needles? Apparently more than I thought. Sunnybrook anaesthesiologist Dr. Colin McCartney and I shared a good chuckle when he admitted he hates them, too. “I don’t mind giving them, but receiving them is another matter! I’m as frightened of needles as anybody!” (Just in case you were wondering, yes, the irony is duly noted.)

But that could partly be what has fuelled his passion to make the whole experience of receiving an anesthetic as pleasant as possible. Traditionally, to find the right spot to inject the needle, nerve stimulation would be used. But that’s an imprecise method, often leading to several tries while the patient starts feeling like a human pin cushion. It also leads to a higher risk of other complications, like bleeding, convulsions and even nerve injury.

Dr. McCartney has been a leader in studying and teaching a better method, which uses ultrasound to literally lay out a roadmap of where the needle and anesthetic need to go. It’s a brilliant concept that has been shown to work very well, and make patients like Stanley Hurst a lot happier.

To fill you in on Stanley’s story, in short, he’s had a rough go. He was doing some repairs on his cottage roof when he lost his footing and fell. Instead of landing on both feet, the impact was absorbed by only one, causing those ankle bones to shatter. When I met him, he was being prepped for surgery number 7 at Sunnybrook’s Holland Orthopedic and Arthritic Centre. Dr. McCartney administered his anesthesia using the ultrasound-guided technique, while Stanley looked on in interest. “Actually, it feels more comfortable knowing what’s going on.”

Knowing the lowly needle is up there among the most dreaded symbols of health care, Dr. McCartney says distraction can be a great thing for the patient. Stanley didn’t even flinch as the needle went in, too wrapped up in the black and white scene unfolding on the screen in front of him. And most importantly, he got the right dose in the right spot.

The ultrasound-guided technique is becoming more common in surgical suites across Ontario, but there are some bumps in the road. It takes a lot of training, and some ultrasound machines cost as much as a Lexus. That said, the benefits to the patient are amazing. I’ll go out on a limb and estimate fainting rates across the province will fall by 90% (myself included).

For a link to Dr. McCartney’s blog, click here.

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