Pain management is an integral part of your overall ankle replacement treatment plan. With your assistance and cooperation in communicating your pain, we can establish a realistic pain relief goal and develop ways to achieve this goal.

Inpatient Pain Management

While in the hospital, you will be asked often if you are having pain:

What type of pain do you have? Words to describe your pain may include sharp, dull, stabbing, shooting, burning, crushing, or pins and needle.

How much pain do you have? You can describe the intensity of the pain on a scale of zero to 10. Zero is no pain, and 10 is the worst possible pain you can imagine.

Where is the pain located? Is it at the surgical site or somewhere else? Does the pain stay in one place or does it move?

Pain Management After Ankle Replacement Surgery

There are a number of ways to manage your pain after surgery. Your doctor will discuss your options and recommended the best method of pain management for you. Please feel free to ask questions along the way.

• Epidural catheter: Pain medication is given through a tiny flexible tube inserted into your back. The catheter is removed prior to hospital discharge, at which time you would  switch to oral narcotic pain medication.
• Regional catheter: Pain medication is given through a tiny flexible tube inserted next to a nerve. In total ankle replacement, we place this catheter behind the knee or behind the hip on the same side as the surgery. We often send people home with this catheter in place to continue to deliver medication at home. The catheter is then removed at home two to three days after surgery. At that time you will be switched to oral narcotic pain medication.
• Oral medication: Oral pain medication will be provided at some point in your postoperative care. We will give you specific medication to be taken at specific times to control your pain. We will review the instructions with you prior to your discharge from the hospital.

If you have unbearable pain, contact your doctor or the hospital where you had your surgery. We will work with you to better manage your pain. Please do not call the central appointment number, as they will be unable to assist you.

Opioid Side Effects

Opioids (narcotics) are one type of medication that may be used to control your pain after surgery. Examples of these medications include OxyContin, oxycodone, hydrocodone, Percocet, and Vicodin. Each medication has its own side effects; listed below you will find some of the most common side effects of opioids and how we manage them.

• Nausea and vomiting: Medications are available to help with nausea and vomiting, so please let us know if you are having these side effects. Other ways to help manage these side effects are to eat small amounts of bland food and take sips of clear liquids.
• Itching: There are medications that can relieve the problem of itching. Please tell your nurse if you are in the hospital or call your doctor’s office if you have been discharged.
• Sleepiness: It is not uncommon to be sleepy after surgery, and the nursing staff will check on you on a regular basis while you are in the hospital to make sure you are not too sleepy. This sometimes includes waking you up if you are asleep. If you are too sleepy, then you may not breathe well and develop problems as a result. We may change medications if you are too sleepy.
• Constipation: Stool softeners are often given to help with constipation. People sometimes need a laxative if they have not had a bowel movement for a few days. Keeping a highfiber diet and eating lots of fruits and vegetables will help as well. It is also recommended that you eat very light meals for a few days before surgery.

Other Ways to Relieve Pain

• Keeping your foot and ankle elevated above your heart for the first four to five days after surgery will reduce swelling in the ankle and significantly decrease pain. Remember: Toes above your nose.
• Repositioning your foot and ankle from time to time -- while keeping it elevated -- will also decrease pain.
• Using relaxation techniques will help with pain management. Pain and anxiety feed off each other, so being relaxed and calm can affect your level of pain. If you usually take medication for anxiety, then taking it after surgery will be helpful.
• Avoiding caffeine as much as possible (i.e., coffee, tea, cola) will help to decrease restlessness or anxiety.
• Focusing on television, music, or visitors can take your mind off mild pain. Use any of these distraction tools to help reduce pain.

At Duke, our goal for pain management is to keep you comfortable and safe.