Exploring the Arsenal: What do surgeons use to reduce pain?

October 13, 2025 •

5 min read

The effective management of pain is a cornerstone of modern surgical care, with protocols evolving significantly to improve patient outcomes and reduce opioid dependence. To achieve this, what do surgeons use to reduce pain is a complex, multi-faceted strategy that combines various medications and techniques tailored to the individual patient and procedure.

Quick Summary

Surgeons use a combination of general, regional, and local anesthesia, along with opioids, NSAIDs, and other non-opioid medications, delivered via various methods, to control pain during and after surgery.

Key Points

Multimodal Analgesia: The modern standard for surgical pain relief uses a combination of drugs and methods to target different pain pathways, reducing reliance on opioids.
Anesthesia Types: General anesthesia provides unconsciousness for major surgery, while regional and local anesthetics numb specific body areas, often for longer-lasting, targeted relief.
Key Medications: The pharmacological arsenal includes potent opioids for severe pain, non-opioid NSAIDs and acetaminophen for milder pain and inflammation, and other adjunct medications.
Advanced Delivery Methods: Techniques like Patient-Controlled Analgesia (PCA) and epidural catheters give patients more control over their pain relief and can provide continuous medication.
Non-Pharmacological Aids: Non-drug methods such as ice, heat, physical therapy, and relaxation techniques are used alongside medication to provide more comprehensive comfort.
Focus on Opioid Stewardship: Modern protocols emphasize minimizing opioid use to reduce the risk of side effects and dependence, particularly in the post-operative period.
Personalized Plans: The specific pain management approach is highly individualized, depending on the type of surgery, patient health, and pain tolerance.

The Multimodal Approach to Surgical Pain Management

For many years, opioid analgesics were the primary method for controlling post-operative pain. However, due to concerns about side effects and the potential for addiction, a new standard has emerged: multimodal analgesia. This strategy involves using a combination of different medications and techniques that target pain pathways through various mechanisms, often reducing the total dose of opioids required. This approach not only provides more comprehensive pain relief but also minimizes the risk of opioid-related side effects like constipation, nausea, and respiratory depression.

Preoperative Planning for Pain Control

Effective pain management begins even before the patient enters the operating room. During the preoperative consultation, the anesthesiologist and surgeon will review the patient's medical history, pain tolerance, and any pre-existing conditions. This evaluation helps create a customized pain management plan that considers the type of surgery and the patient's individual needs. For patients already taking opioids, a careful weaning or management plan is crucial to prevent tolerance and complications.

Pharmacological Tools in the Surgeon's Arsenal

Surgeons and anesthesiologists employ a wide range of medications to manage pain throughout the surgical process.

General Anesthesia

For major surgeries, general anesthesia is used to render the patient unconscious and unaware of the procedure. A variety of medications are involved, including intravenous drugs to induce sleep (such as propofol) and inhaled anesthetic gases to maintain the deep sleep-like state. Pain relief is a key component, with anesthesiologists administering strong pain medicines, often opioids, intravenously during the operation.

Regional Anesthesia

Regional anesthesia numbs a larger area of the body, such as an arm, leg, or the lower half of the body, allowing the patient to remain conscious or lightly sedated. This method blocks pain signals from reaching the brain and can provide longer-lasting relief with fewer side effects compared to general anesthesia. Examples include:

Epidural Analgesia: Pain medicine is injected into the epidural space of the spinal canal through a catheter, commonly used for childbirth or major abdominal surgery. The catheter can stay in place for several days to manage post-operative pain.
Spinal Anesthesia: A single, faster-acting dose is injected directly into the spinal fluid, providing relief for shorter procedures.
Nerve Blocks: A local anesthetic is injected near a nerve cluster to block pain signals to a specific area. This can be used for procedures on limbs and can provide long-lasting pain control after surgery.

Local Anesthetics

These are used to numb a very small, specific area of the body for minor procedures or wound sites. A surgeon may inject lidocaine or bupivacaine at the surgical site to provide pain relief for the initial hours after the operation. Newer, liposomal formulations of local anesthetics, like liposomal bupivacaine, can provide extended pain relief for up to 72 hours.

Opioid Analgesics

Opioids are potent painkillers that work by binding to receptors in the central nervous system to reduce the perception of pain. They are highly effective for severe pain but carry significant risks, including dependence and addiction. Common opioids used in surgery include:

Fentanyl
Morphine
Hydromorphone
Oxycodone

They can be administered intravenously in the hospital or prescribed as oral pills for short-term at-home use.

Non-Opioid Pain Relievers

These medications are crucial to multimodal analgesia, reducing the need for opioids. They include:

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These reduce pain and inflammation by blocking the cyclooxygenase (COX) enzyme. Examples include ibuprofen, naproxen, and intravenous ketorolac.
Acetaminophen: An effective pain reliever that works by elevating the body’s pain threshold, often used in combination with other drugs.
Adjunct Medications: Other drugs like gabapentin (an anti-seizure medication) and ketamine (an anesthetic) can also be used to manage pain.

Methods of Medication Delivery

Beyond the type of medication, how it is delivered is also critical for effective pain control.

Intravenous (IV) Infusion: Pain medications are delivered directly into a vein. This allows for rapid and precise control of pain levels in the hospital setting.
Patient-Controlled Analgesia (PCA): A machine allows patients to self-administer a set dose of intravenous pain medication, such as an opioid, by pressing a button. The device has built-in safety features to prevent overdosing.
Catheter-Based Delivery: For epidurals or nerve blocks, a small catheter can be left in place to provide a continuous or patient-controlled flow of pain medication over several days, offering prolonged relief.

A Comparison of Pain Management Techniques


Technique	Primary Mechanism	Best For	Pros	Cons
General Anesthesia	Induces unconsciousness and blocks all sensation.	Major, long, or invasive surgeries.	Complete pain block, no awareness of surgery.	Potential for side effects like nausea and drowsiness.
Regional Anesthesia	Numbing a specific region of the body via nerve block.	Procedures on limbs or lower body, or labor.	Extended pain relief, reduced opioid needs.	Catheter placement can be complex.
Local Anesthetics	Numbing a very small, specific area at the incision site.	Minor procedures, wound infiltration post-surgery.	Targeted relief, minimal systemic side effects.	Short duration unless slow-release formulas are used.
Opioid Analgesics	Blocks pain signals in the central nervous system.	Severe, acute pain.	Highly effective for strong pain.	Side effects include constipation, drowsiness; risk of addiction.
Non-Opioid Analgesics	Reduces pain and inflammation (NSAIDs) or raises pain threshold (Acetaminophen).	Mild to moderate pain, adjunct to opioids.	Fewer side effects, no risk of addiction.	Less effective for severe pain.

Non-Pharmacological Strategies for Pain Reduction

In addition to medication, non-pharmacological methods are an important part of a holistic pain management plan.

Ice and Heat: Applying ice packs can help reduce post-operative swelling and pain, while heat can soothe muscle aches.
Physical Therapy: Targeted exercises can help restore strength and range of motion, reducing pain over time.
Relaxation Techniques: Mindfulness, meditation, and deep breathing can help manage pain perception and anxiety.
Distraction: Engaging in activities like listening to music, watching TV, or talking to others can help shift focus away from pain.

The Modern Emphasis on Opioid Stewardship

With rising concerns about opioid misuse, there is a strong movement towards "opioid stewardship" in the surgical field. This involves minimizing the use of opioids by prioritizing multimodal analgesia, starting with non-opioid options, and using opioids judiciously for severe, breakthrough pain. Communication between the hospital team and the primary care physician is also vital to ensure that patients are not continued on opioids unnecessarily after discharge.

Conclusion

Surgeons and anesthesiologists use a sophisticated, multi-pronged approach to manage pain, leveraging a combination of pharmacological and non-pharmacological techniques. This starts with a pre-operative assessment and continues through the post-operative recovery period. By combining general, regional, and local anesthetics with a mix of non-opioid and opioid analgesics, they can provide effective pain relief while minimizing risks. Ultimately, the modern standard of care is a personalized multimodal strategy designed to optimize patient comfort, accelerate recovery, and promote responsible medication use.

Frequently Asked Questions

General anesthesia puts you completely to sleep and blocks all feeling and awareness during major surgery. Regional anesthesia numbs only a specific part of your body, such as an arm or leg, while you remain conscious or lightly sedated.

No, while opioids are used for severe, acute pain, they are not the only option. The modern approach, known as multimodal analgesia, combines opioids with other non-opioid medications and regional techniques to provide more effective pain relief and reduce the amount of opioids needed.

PCA is a system that allows a patient to give themselves a dose of intravenous pain medicine, usually an opioid, by pressing a button. The machine is programmed with safety limits to prevent accidental overdosing.

Nerve blocks are used to provide targeted pain relief to a specific area of the body by injecting a local anesthetic near a nerve cluster. This can significantly reduce post-operative pain and lessen the need for other pain medications, including opioids.

Non-opioid pain relievers include Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) like ibuprofen or ketorolac, and acetaminophen. They are often used in conjunction with other methods to manage mild-to-moderate pain and inflammation.

Yes. Non-pharmacological methods like applying ice packs to reduce swelling, using relaxation techniques, or engaging in distracting activities can be effective complementary tools for managing surgical pain.

The duration depends on the type of surgery and individual healing. For most patients, pain is significantly reduced within a few days. Doctors aim to transition patients off stronger medications, like opioids, as quickly as possible and may recommend over-the-counter options for longer-term management.