Medical care for SRS patients at Chettawut Plastic Surgery Center

Pain Management After Sex Reassignment Surgery (SRS)

Opioid Medications

Opioids (Narcotics) such as Morphine or Demerol (Pethidine) are the primary analgesics for pain management, typically administered during the first 24 hours after surgery.

Additional Analgesics

Epidural Block

The epidural block is a local anesthetic method performed while you are unconscious from general anesthesia. This minimizes the side effects of general anesthesia and significantly controls post-surgery pain. Pain medications (Marcaine and Morphine) are delivered through a catheter placed in the small of your back, just outside your spinal canal. This optional method can be discussed with our anesthesiologist before surgery.

Injectable Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

We use COX2 selective inhibitors during the operation to control pain after surgery.

Potent Pain Relievers

Tramadol, a narcotic-like pain medication, can be administered via intra-muscular or intravenous injection to treat severe pain. Oral tramadol is routinely provided every 4-6 hours to control moderate pain. Additionally, oral NSAIDs (e.g., Celebrex), muscle relaxants (e.g., Tolperisone), and sedative medications provide synergistic pain management post-SRS.

Pain Assessment

Pain is highly subjective, meaning only you know the level of pain you are experiencing. Our medical team will ask you to rate your pain using a scale from 0-10 to determine the appropriate pharmacologic and non-pharmacologic interventions for substantial relief and comfort.

Prophylactic Antibiotics and Anti-Nausea Medication

Prophylactic antibiotics are routinely administered through IV during the operation and the early recovery stage. We use a combination of broad-spectrum antibiotics (e.g., Cefazolin or Augmentin) to eliminate infection risks. Ondansetron, a strong anti-emetic drug, is administered by our anesthesiologist, often combined with Metoclopramide during general anesthesia and post-surgery to ensure a smooth recovery without nausea or vomiting. Oral home medications, including antibiotics, anti-swelling, anti-pain (Tramadol & Paracetamol), anti-inflammatory (NSAID), and muscle relaxants, are provided throughout recovery.

Prevention of Perioperative Hypothermia

Prevention of Deep Vein Thrombosis (DVT) and Compartment Syndrome

For all major surgeries, a Pneumatic intermittent pumping device is used during general anesthesia and the first 2 days post-operative period to prevent DVT. Prolonged operations in the lithotomy position can pressure the lower leg, leading to neuromuscular dysfunction. Using specially designed silicone cushions and pneumatic intermittent pumping devices significantly prevent leg problems, including pain, weakness, numbness, DVT, and compartment syndrome. Dr. Chettawut’s leg lifting exercise technique ensures good blood circulation during the lithotomy position. Post-SRS, patients are encouraged to flex & extend ankles and raise legs up to 30 degrees for active leg movement.

Care of the Urinary Catheter and Urine Bag

Urinary catheterization is a routine procedure during SRS to prevent urine contamination of the new wound during surgery and the early post-operative period. The urinary catheter, with an inflated balloon at the end, prevents it from sliding out. Removal typically occurs between post-operative days 10-12, with earlier removal potentially causing urination difficulties due to swelling around the newly constructed urethral opening. The catheter and tube are strapped to the lower abdomen to ensure normal urine drainage. The urine bag should be emptied when it reaches around 800 cc (half full) by opening the T valve. After emptying, the T valve is closed by pushing the rod back to its original position. After catheter removal, staying relaxed and drinking plenty of water will facilitate easy urination.