Pain management after discharge

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HIP • KNEE • SHOULDER • FOOT AND ANKLE • TRAUMA • SPORTS INJURIES

Pain management after discharge

Pain management after your discharge from the ward can be confusing and complicated. Hopefully this information will give you some guidance. If you need further advice, please ring the ward, your own doctor, or the rooms for advice.

Everyone is different, and your pain requirement may be more or less than the examples below. Usually hip replacements are much less painful than knees.

Routine discharge medicines after joint replacements (hips and knees):

Paracetamol for as long as necessary (e.g. PanadolOsteo, Panamax).
NSAIDS for minimum of six weeks (e.g. meloxicam, Celebrex, ibuprofen (Nurofen)).
Buprenorphine patch for three weeks (e.g. Norspan).
Long-acting opiate for 2–6 weeks (e.g. Targin, Oxycodone, Tramadol SR).
Short-acting opiate for 2–6 weeks (e.g. Endone, Tramadol).
Ice for three months or more (knees).
Aspirin for four weeks (reduces chance of thrombosis, pulmonary embolus, heart attack and stroke).

Other common discharge medicines:

Pain modulators: sometimes required, especially with chronic pain (e.g. Lyrica).
Iron and Folate: usually for two weeks, to replenish your stores.
Clexane/warfarin: for people with increased risk of thrombosis.

Following your discharge, the aim for most pain medications is to gradually remove them (wean) as required.

Total Knee Replacement—Example Pain Plan

First 1–3 weeks after discharge

Keep swelling down with ice (knees) four times a day for no more than 20 minutes. Especially good after exercise/physiotherapy.
Anti-inflammatory for minimum of six weeks unless you have a problem taking them (contraindication—such as gastric ulcers, kidney problems or oesophageal reflux). Always take with food.
Buprenorphine patch should be on your upper chest, and changed weekly. If you feel nauseous, then move it down your arm.
Long-acting opiate, typically twice a day.
Short acting opiate/opioid and paracetamol take as necessary.

2–8 weeks after discharge

Wean off the short acting opiates, and morning dose of long-acting opiates.
Keep the night-time long-acting opiate to get a good night's sleep.

6+ weeks after discharge

Usually off all opiates.
Paracetamol and anti-inflammatory as needed.

Total Hip Replacement—Example Pain Plan

First 1–3 weeks after discharge

Anti-inflammatory for minimum of 4 weeks unless you have a problem taking them (contraindication—such as gastric ulcers, kidney problems or oesophageal reflux). Always take with food.
Buprenorphine patch should be on your upper chest, and changed weekly. If you feel nauseous, then move it down your arm.
Long-acting opiate, typically twice a day.
Short acting opiate/opioid and paracetamol take as necessary.

1–6 weeks after discharge

Wean off the short acting opiates, and morning dose of long-acting opiates.
Keep the night-time long-acting opiate to get a good night's sleep.

3–6+ weeks after discharge

Usually off all opiates.
Paracetamol and NSAIDS as needed.

Day Case Surgery/Fractures: Example Pain Plan

Usually you are discharged on anti-inflammatory, and paracetamol, with a few doses of strong painkillers for the first few days (Tramadol, Endone).
Ice is great for knees and ankles.
Elevation if possible is good, especially ankles, and arm injuries.