Managing pain expectations...
March 25, 2010 8:49 AM   Subscribe

Minor surgery (in this case, laparoscopic tubal ligation)-- without pain meds. What can I expect?

In three weeks I will undergo minor laparoscopic surgery for a tubal ligation and to explore what might be wrong with one of my ovaries. Let me say first that there are no doubts between myself and my partner that the tubal ligation is what we want and I've had plenty of discussion with medical professionals in making this determination.

I'm aware that there have been a number of threads on the topic of tubal ligations in the past, but I have two specific questions:

1. I am a recovering drug addict (2.5 years clean/sober) and will only be able to take prescription NSAIDs for the inflammation (naproxen or high-dose ibuprofen). What can I expect, pain-wise? Does anyone have any experiences with laparoscopic surgery (of any kind) without the use of opioids/narcotics (for any reason)? Most patients who have related their experience online describe their pain level with the pain meds, but I would really like to hear from those who didn't have that option. As with a lot of addicts still relatively fresh in recovery, I medicated pain away for so long that I have a lower tolerance for it than I would if I hadn't been using. That said, I'm not so much afraid of the pain-- I'd just really appreciate some idea as to what to expect in advance.

2. I live 4.5 hours away from the hospital where the procedure will be performed. If the surgery goes without complications, how realistic would it be for me to be driven the 4.5 hours home the day after the surgery? Would I be in substantial discomfort in the car / in that seated position for that duration considering the pain management restrictions?

Some additional details about the surgery:
During the procedure, there will also be some exploration to try to figure out what is causing my years-long ovarian pain on one side-- if it is just scar tissue built up from burst cysts, then they'll clean it up at the same time. There will be two very small incisions-- one in my navel (which makes me ten kinds of squeamish, but that's not really relevant), and one above my pubic bone. They will be inflating my abdomen with CO2 gas so that they can see better-- this gas can remain in the system for up to a week and can cause a fair amount of discomfort, but as I have chronic IBS this is a known quantity for me, and I know how I handle this type of pain. They will be using the titanium clamp method for the tubal ligation itself, and will laser any scar tissue on my ovary if necessary. I will be under for 20 to 40 minutes depending on what they find, followed by 40 minutes of recovery time, then 2 hours of observation, and then I'll be released.

This will take place in Alberta, and if anyone has day surgery experience in this province it would be welcome as well.
posted by mireille to Health & Fitness (15 answers total)
 
It's not precisely what yo u're asking for, but -- I had a c-section and recovered only with strong ibuprofen. (Most pain meds make me vomit.) The first couple of days were not pleasant, but I could lie in bed, and get myself up to use the bathroom. After that, I spent a couple of days in lighter pain but still taking the meds exactly on schedule. A couple of days after that, I had less of a need to take the med exactly on schedule -- could let it go longer without taking it. Just progressing slowly. So it is definitely possible.
posted by BlahLaLa at 9:00 AM on March 25, 2010


I had a laparoscopic tubal ligation several years ago, and here are my recollections about it as it relates to your questions:

1. I took only ibuprofen for the pain, if that. Although for other reasons, I also avoid any sort of opioids or narcotics. My recollection is that the level of pain was really very minimal. The worst of it was that, for a few weeks following the tubal ligation, any sort of nonstretchy waistband was pretty uncomfortable especially when I bent over.

2. A 4.5 hour car ride can be uncomfortable under the best of circumstances, especially if the ride is bumpy. Would it be possible for you to stretch out on the backseat if and when sitting up (with a seatbelt across your lap) gets too tiring?

And just FYI, since they generally lay you back with your feet above your head for the surgery, any residual pain from the CO2 gas usually ends up in the region of your shoulders. I don't recall experiencing any lingering discomfort from the gas, although I was warned to expect it.
posted by DrGail at 9:02 AM on March 25, 2010


My wife went from labor and delivery into another room for a tubal ligation. She still had some effects from the epidural, but as she was breast feeding aftewards, she did not use any opiates or pain meds of any kind that I can recall. She did ok, but that is from my vantage point although she never complained.
posted by JohnnyGunn at 9:04 AM on March 25, 2010


I had a laprascopic surgery last January. The worst part was the gas. It's not farty type gas that you can just pass because it's not in your intestines. It has to be reabsorbed. They may be using it to inflate your abdomen, but it rises. The pain mostly appeared in my shoulders. Heat and massage helped.
posted by elsietheeel at 9:07 AM on March 25, 2010 [1 favorite]


I had laparoscopic surgery last year when I had my gallbladder removed. I too had an incision in my navel (along with two further up on one side). And although I did take opiates (codeine) for the pain, I certainly didn't spend the entire recovery too doped up to know what the pain felt like.

The pain after laparoscopic surgery seemed to me to be entirely due to the muscle damage, in the sense that there was little to no pain unless I was doing something that required the use of abdominal muscles (i.e. sitting down, getting out of bed, lifting things). Sleeping on your back in a semi-upright position for a couple of days might be more confortable. The pain from the CO2 is a bit like a muscle cramp, and usually appears in one shoulder. It's bearable - kind of like the pain you get if you've accidentally reached too far to scratch your back, and pulled a muscle. So generally, sit still and get help when you need to sit or lie down; within a couple of days the worst will be over and you'll be back on your feel and (carefully) doing normal stuff.
posted by le morte de bea arthur at 9:11 AM on March 25, 2010


I had laparascopic appendectomy about 6 years ago. (Incision points are exactly where yours will be.) The pain before the operation (from the appendicitis) was far worse than the pain after the operation. I recall waking up the morning after and feeling so hungry--I asked for bacon and eggs! They took that as a sign it was OK for me to go home. I did have to be careful about being too active in the 6 weeks post-op in order to avoid adhesions. I didn't have any pain from the CO2--just farting. I was 25 at the time and generally was in great health.

Regarding the pain meds I took, I relegated myself to ibuprofen after I figured out that my nausea and vomiting was caused by the Lortab I was prescribed. I did just fine on 800 mg and smaller doses of ibuprofen. (I don't do naproxen well, for some reason.) Anyway, I also got the 800 mg ibuprofen after giving birth, and it did the trick. The key is to take them on a regular basis, even if you are feeling OK, for about a week. It's kind of like when you take ibuprofen ahead of getting your period to help with the cramps.

Best of luck. I hope things resolve for you. Please take it easy and let others do things for you.
posted by FergieBelle at 9:32 AM on March 25, 2010


I had laparoscopic surgery about 18 months ago and got through the pain just fine with 800mg ibuprofen. I didn't take Vicodin or hydrocodeine because they make me nauseated and dizzy. Make sure you get the prescription-strength ibuprofen from your doc, and take doses before you think you need to (i.e., before you start feeling pain).

Like everyone says upthread, the gas deflating in my abdomen and shoulders was the most painful -- and that went away after a day or so. My incisions didn't hurt much, but the bloated feeling and the general heaviness stuck around. I wore a lot of elasticated clothing during that time because it was uncomfortable to have clothes so tight around my waist.

I had scar tissue on my upper bowel and right ovary from endometriosis that they cleaned up at the same time, but can't say I could detect any specific pain in particular areas. Just make sure you rest up and take it easy. I had two weeks off work and that seemed about right.

And good luck!
posted by vickyverky at 10:00 AM on March 25, 2010


I had this procedure done and the pain was minimal. I do recall some minor discomfort in my shoulders from the gas and that was it. The incisions were really small and didn't really hurt. The worst part for me was the anesthesia. I still felt groggy the next day. But, I had it done on a Friday and went back to work on Monday with no problems at all. Good luck!
posted by lawhound at 10:19 AM on March 25, 2010


I've found some research papers on pain management after "laproscopic sterilization" for women that suggest that most people rate the pain prior to taking pain meds to be 7/10 (considered severe). One study compared the pain from tubal cauterization vs. clamping and it seems like clamping has slightly higher pain. The pain from the sterlization was compared to colic pain, so your experience with IBS might be useful for dealing with that part of the pain, if not from the pain of the laproscopic surgery.
Most of the articles are referenced in this paper. Let me know if you'd like a copy to read.
I hope this is helpful. I know you asked for personal experience, but I thought this might be nice too.
Best of luck! Make sure you have a sick bag for the car ride home. I've always been nauseous on car rides after surgery.
posted by nprigoda at 10:29 AM on March 25, 2010


I've had laproscopic surgery and high doses of ibuprofen are the way to go. I think you'll be fine. One piece of advice I've given to others having surgery is that the third day of recovery after surgery seems to be the worst.

I don't know why, but the first day after you'll usually be in a little pain, but you'll expect it and take your ibuprofen. You deal with it. On the second day you start to feel, "This is a breeze. I can do this. I'm going to be fine," and then, somehow, the third day comes on and it's tougher. So just don't be blind-sided it that happens to you, too!
posted by misha at 11:53 AM on March 25, 2010


My experience was really minimal pain - I don't think I wanted more than ibuprofin afterwards. That is a long car ride though - the suggestion of stretching out in back (bring pillows!) is a good one. I don't remember having particular trouble with pain from the gas after the surgery. Can't speak to how the exploratory aspect of the surgery may change how you feel afterwards. I've had other laparascopic surgery that was a rougher recovery but the tubal ligation really was a piece of cake for me. If you are prone to nausea be sure to mention it to the anesthesiologist - I've found that they can tweak the drugs they give you to really help minimize that.
posted by leslies at 12:16 PM on March 25, 2010


I had a very similar experience as le morte de bea arthur when I had laparoscopic surgery to remove my gallbladder last year. The pain happened when I had to move around, not so much when I was laying still. I did have to sleep laying sitting up for about a week for breathing purposes but also because laying flat or on my side was extremely uncomfortable. Getting up from the couch was difficult the first few days as was raising my arms over my head to shampoo. After the first few days I could manage on my own though, albeit slowly and stiffly. I did take vicodin the first few days, but I wasn't a huge fan and cycled that with motrin which worked extremely well. Also, I'm a total wimp when it comes to pain.

The worst was the shoulder pain from the gas. It made it difficult for me to breathe deeply and it was way more painful than the incisions or the soreness from the surgery and drugs didn't help with that anyway.
posted by Kimberly at 12:26 PM on March 25, 2010


I'm not sure where the incisions will be, but honestly, the pain of recovery was nothing compared to having to figure out what to wear that wouldn't cause friction against incisions in the hip/front pelvic area. I spent a lot of time in low-slung sweatpants, and breezy skirts...

I had a laparoscopy for ovarian cysts and the pain wasn't really a big deal- some minor stitch pain if I stretched too far in one direction, and like others have said, the inflation/pain from the gas dissipating, but I think I spent 1-2 days on the prescription pain meds, then moved to steady doses of naproxen or Advil. I could have probably skipped out on the pain meds entirely, and I am generally not one of those people that deals with pain well.
posted by rachaelfaith at 12:38 PM on March 25, 2010


Laparoscopic tubal ligation:

if you are having a general anaesthetic, make sure they give you an anti-nausea medication to take home like Maxolon. This is not a painkiller, and does not contain any opioids, but will help with the severe nausea you may have when you wake up, and for 6 hours afterwards.

Seriously. For about six hours after I woke up I felt like I was going to throw up any second.

It was painful. I was expecting it to be very painful, but it was even more painful than I expected. I had three shots of whatever the nurse gave me in recovery - I don't know if it was an opiate or not, but it didn't make me sleepy - and it barely scratched the pain.

If you're avoiding opiate painkillers - talk to your GP about wheat packs (microwave them) and ice packs - would applying heat or cold alleviate pain? Definitely look into ibruprofen, voltaren, paracetemol and find out what is the best option for you.

I would avoid the 4.5 hour drive afterwards if you can find somewhere to stay overnight that is more local.

Even with paracetemol + codeine, I was in so much pain for the 10 hours post surgery that I was curled up in a ball on the couch, or lying flat on the floor, sobbing because it hurt so much.

You don't want to be in a car if that turns out to be your experience (and obviously, I hope it doesn't ^_^), because you won't be able to lie flat / move around if you need to.

Lastly, the surgeons tend to underestimate the recovery time - I had surgery on Thursday and went back to work on Monday, and this was a big mistake. If I did it over, I would take at least 7 days off work to heal.

You will be in pain, and needing to walk slowly, and rest more than usual, for 6 to 8 weeks afterwards.

Good luck! ^_^
posted by Oceanesque at 1:32 PM on March 25, 2010


Thanks, everyone, for the input and the kind wishes. Using your suggestions, here are the additions to my plan:

I'll bring a heating pad for the hotel for the shoulder pain (and possibly stay an additional night, depending on how I feel), I'll bring extra pillows for the car as I'll likely need to lay down (although I'll probably recline in the passenger seat with the seatbelt on), I'll check with the anaesthesiologist about the nausea, I'll stay on top of the ibuprofen as suggested, and I'll plan to take it extra-easy afterwards.

I'll report back after I've recovered!
posted by mireille at 6:19 PM on March 25, 2010


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