Common Medications Before, During, and After Surgery

The drugs commonly used before, during, and after surgical procedures vary widely from patient to patient. This is because the specific drugs you receive are based on the type of surgery you are having, the anesthesia you will be undergoing, and any underlying health problems you have.  

Before surgery, you will meet your anesthesiologist. At this visit, you will review all your medical and dental problems and allergies, as well as any medicines you are taking, including herbal supplements, vitamins, and any over-the-counter drugs like aspirin.

In addition, be sure to tell your anesthesiologist whether you take illegal drugs, smoke, or drink alcohol, as all of these substances may affect how well you heal from your surgery and how well the anesthesia drugs work.

On a side note, it's important to note that quitting smoking is ideal prior to surgery as it will lower your risk of lung complications after surgery, most notably pneumonia.  Your anesthesiologist will also inquire whether you or a family member has ever had a bad reaction before to anesthesia. 

In terms of medications, prior to surgery, an antibiotic may be given to prevent infections at the surgical site. Antibiotics are a category of drugs used to combat bacteria, and they are generally given orally (in pill form), or intravenously (through an IV). 

The selection of the antibiotic depends on the type of surgery a person is having, and its purpose is to prevent an infection at the surgical site. For example, a person undergoing a coronary artery bypass surgery may receive an antibiotic called Ancef (cefazolin) within one hour prior to the incision (surgical cut) being made. Ancef is given through the vein (IV), and it's a first generation cephalosporin with a similar structure to penicillin.

There are three different types of anesthesia:

• Local Anesthesia: You are awake, and a medication is injected into the skin to numb or block pain in a specific site of the body (for example, removal of a mole on a person's back).
• Regional Anesthesia: You are awake, and a medication is injected into an area of nerves to numb the part of the body that is undergoing surgery (for example, an epidural during labor and childbirth).
• General Anesthesia: You are asleep, and a medication is given to stop pain from being felt anywhere in the body (for example, a surgery to remove a person's gallbladder or appendix).

Most major surgical procedures require general anesthesia. With general anesthesia, a medication called an anesthetic is used to induce unconsciousness and ensure you do not feel any pain. It can either be given through the vein (intravenously) or through a breathing mask or tube. An example of an anesthetic often used to induce anesthesia is propofol. 

Sometimes, a breathing tube is placed into a person's windpipe by an anesthesiologist to make sure a person breathes properly during the surgery. In addition, a medication called a paralytic may be used along with an anesthetic to deeply relax the muscles of a person's body during surgery.

Barbiturates and benzodiazepines, commonly known as “downers” or sedatives, are two related classes of prescription medications that are used to depress the central nervous system. They are sometimes used with anesthesia to calm a patient down just prior to surgery of during their recovery.

Three examples of benzodiazepines sometimes used for sedation include:

• Ativan (lorazepam)
• Valium (diazepam)
• Versed (midazolam)

After a person has completed surgery in an operation room, he will go to a recovery room where nurses will closely monitor vitals (for example, heart rate, breathing rate, and blood pressure), and ensure adequate pain control as the person begins to fully wake up from the anesthesia.

If staying overnight, a person will eventually move to a hospital room for further rest, recovery, and pain management. Once in the hospital room, nurses and doctors will continue to monitor vitals as well as urine output and the rate of intravenous fluids.

Surgeons may also have specific instructions for the surgical incision site, like how to provide proper wound care, and order blood tests to check for signs of bleeding or infection.

In addition to these aftercare instructions, medications like pain relievers will be given in order to keep pain at bay while the body heals.

Analgesics, or pain medications, are used to control pain after surgery. They are available in a wide variety of forms and can be given in a number of ways like through an IV, pill form, lozenge, suppository, liquid, and even as a patch, where the medication is absorbed through the skin.

The strength of individual pain medications varies widely, just as the dosage prescribed by a physician can be different from one patient to another. For this reason, the medication prescribed will depend greatly on the condition for which it is prescribed.

Many post-operative analgesics contain opioids, either purely or in combination with acetaminophen or NSAIDs.

Commonly prescribed pain-easing medications given in the hospital after surgery through a person's vein include Duramorph (morphine) and Dilaudid (hydromorphone) which are opioids.

Upon discharge from surgery, opioid pain medications are given in the form of Lortab or Vicodin (acetaminophen/hydrocodone) and Percocet (acetaminophen/oxycodone).

Other post-surgical pain-easing medications that your doctor may recommend include:

• Ultram (tramadol)
• NSAIDs (for example, ibuprofen)
• Tylenol (acetaminophen)

Another very important medication often given after surgery is an anticoagulant, which is a medication that slows the clotting of the blood. This is critical as one of the risks of surgery is blood clots, especially deep vein thrombosis, which often occurs in the legs.

To prevent blood clots from forming and causing complications such as a stroke or a pulmonary embolus (a clot in the lung), anticoagulants are given through an IV, an injection, or in a pill form.

Examples of anticoagulants include:

• Argatroban
• Coumadin (Warfarin)
• Heparin
• Lovenox (Enoxaparin)

Finally, your doctor may prescribe other symptom-reducing medications to ease any discomforts you may have associated with having the surgery or with the pain medications you are taking (nausea and constipation are common with opioids). Examples may include:

• Acid reducers like the H-2 Blocker Pepcid (famotidine)
• Stool softeners and stimulant laxative like Peri-Colace (docusate sodium/sennosides)
• Anti-nausea medications like Zofran (ondansetron)

When it comes to surgery, it is an undeniable fact that medications make procedure more tolerable, the recovery faster and the pain less.  That doesn't mean that medication can take care of everything, because drugs can only do so much to make recovery better.  

A patient with a willingness to get up and move after surgery is going to have a better chance of avoiding pneumonia than the patient who won't get out of bed.  The patient who actively participates in rehabilitation will often be stronger and have a better return to normal activities than the one who has to be coaxed and bribed into doing their exercises.