A: Pain management after sex reassignment surgery
Opioids (Narcotics) medications such as Morphine or Demerol (Pethidine) are considered the primary analgesics for pain management normally administered during the first 24 hours after the surgery.
The additional analgesics which we routinely use are as follows:
1. Epidural block
The epidural block is a local anesthetic method performed when you are already unconscious from general anesthesia.in order to minimize the side effect of anesthetic drugs from general anesthesia and significantly control pain after surgery.The pain medications (Marcaine and Morphine) will be delivered through a tiny tube called a catheter that is placed in the small of your back, just outside your spinal canal.
The epidural block is an optional anesthetic method which the patients can discuss with our anesthesiologist before surgery.
2. Injectable nonsteroidal anti-inflammatory drugs (NSAIDs)
This pain medication is COX2 selective inhibitor that our medical team utilizes during the operation in order to control pain after surgery.
3. Potent pain relievers
Tramadol is a narcotic-like pain medication which can be administered to treat severe pain via intra-muscular or intravenous injection. The oral tramadol preparation is routinely provided every 4-6 hours to control moderate pain.In addition, the use of the oral non-steroidal anti-inflammatory drugs (NSAID medication, for example Celebrex), muscle relaxant (for example Tolperisone), and sedative medication(s) can provide a synergistic effect in managing the pain following SRS.
How do the medical team determine your level of pain?
Pain is highly subjective which means it is only you who knows the level of pain that you are experiencing.
To help determine your level of pain, our medical team will ask you to rate your pain using the pain assessment scale from 0-10.
Through this method, proper pharmacologic and non-pharmacologic interventions will be determined and delivered to promote substantial relief and comfort.
Pain Score used at Chettawut Plastic Surgery Center
B: Prophylactic antibiotics and anti-nausea medication
Prophylactic antibiotics are routinely used through IV (intravenous) line during operation as well as the early stage of recovery.
We use the combination of broad spectrum antibiotics which cover gram positive (for example: Cefazolin or Augmentin) and gram negative (for example: Aminoglycoside or Quinolone group) to eliminate the risk of infection.
The intravenous prophylactic antibiotics can be Cefazolin 1,000 mg or Augmentin (Amoxicillin + clavulanic acid) 1,200 mg.
Our anesthesiologist routinely administers a strong anti-emetic drugs which is Ondansetron. Metoclopramide can be combined with Ondansetron during general anesthesia and also use after surgery to ensure smooth & comfortable recovery without nausea or vomiting.
Oral home medications including antibiotic, anti-swelling, anti-pain (Tramadol & Paracetamol), anti-inflammation (NSAID) and muscle relaxant will be provide during your entire recovery.
C: Prevention of perioperative hypothermia
Forced-air warming therapy is now the standard choice for preventing hypothermia and our surgery center uses the Bair Hugger Models 775 which can provide safe, quiet, and effective warming for patients.
Bair Hugger blankets are designed to efficiently and safely warm and comfort patients when used with Bair Hugger warming units.
For all major surgery at Chettawut plastic surgery center, the use of Bair Hugger will be applied to all patients during general anesthesia and the first 2 hour post-operative period at recovery room.
D: Prevention of deep vein thrombosis (DVT) and compartment syndrome
For all major surgery at Chettawut plastic surgery center, the use of Pneumatic intermittent pumping device will be applied to all patients during general anesthesia and the first 2 day post-operative period at recovery room to prevent deep vein thrombosis (DVT).
A prolonged operation in the lithotomy position can put pressure on the lower leg and lead to neuromuscular dysfunction.
During SRS, the use of specially designed silicone cushion to support patients’ legs during SRS and the use of pneumatic intermittent pumping device can significantly prevent any leg problems including leg muscle pain or weakness, numbness from nerve compression, DVT and compartment syndrome.
Dr. Chettawut‘s leg lifting exercise technique by intermittent passive movement is applied to all SRS patients to ensure good blood circulation during lithotomy position.
While lying on the bed after SRS, we encouraged the patients to flex & extend ankle and also raise leg up to 30 degree for active leg movement.
E: Care of the urinary catheter and urine bag
Urinary catheterization is a routine medical procedure during SRS that carries urine from the bladder to the outside of the body in order to prevent urine contamination to the new wound during surgery and also early post-operative period.
The end of the urinary catheter has an inflated balloon in order to prevent the catheter sliding out of your body.
When the catheter needs to be removed (normally between post-operative day 10-12th), the balloon is deflated.
The difficulty of urination can be expected if the urinary catheter is removed earlier than the above recommended time because of the swelling around newly constructed urethral opening.
The urinary catheter & the tube connecting the catheter and urine bag will be strapped with adhesive bandage on your lower abdomen in proper direction to ensure normal drainage of urine without any resistance or obstruction.
The urine bag should be emptied when the urine occupies around 800 cc (half of bag) by opening the T valve to drain the urine.
At the bottom of the bag, the T valve can be opened by pushing the rod all the way through the opposite direction (for open valve) in order to drain the urine into the toilet or container.
After emptying the urine bag, the T valve can be closed by pushing the rod back to the original position.
After the urinary catheter is removed, it is important that you feel relaxed and drink a plenty of water which allow your first urination become very easy.
Open valve - Empty bag - Close valve