Most patients go home with an SMS eScript token (QR code/link) on their phone.

How to use it: • show the token to any pharmacy • keep it private (don’t share screenshots) • you can ask the price before it is dispensed • Schedule 8 medicines (strong pain medicine) usually require ID

Typical medicines after surgery (layered pain relief): • regular paracetamol • an anti-inflammatory if it is safe for you • a small amount of stronger pain medicine only if needed for breakthrough pain

Good pain relief makes recovery safer and faster. It helps you feel comfortable, breathe deeply and move earlier, reducing the risk of complications such as chest infections and blood clots.

Pain relief ladder:

1. Regular paracetamol

2. Anti-inflammatory (e.g. etoricoxib/celecoxib/ibuprofen)

3. Breakthrough medicine only if needed

Tablets or liquids – paracetamol and anti-inflammatory medicines are used regularly if suitable.

Local anaesthetic injections – spinal/epidural anaesthesia or a nerve block can numb the area and reduce pain markedly.

Stronger medicines (opioids) – such as morphine or oxycodone may be used for more painful surgery. We aim for the lowest effective dose because opioids can cause nausea, constipation, drowsiness, and itch.

Patient-controlled analgesia (PCA) – a button that gives small doses safely through your drip when needed.

Pain relief at home is layered. Use regular medicines first, then add stronger medicine only if needed.

Paracetamol – take regularly for the first 7–14 days after surgery (for example 2 tablets three times daily). Maximum 6 tablets in 24 hours. Do not take other paracetamol-containing medicines (for example cold/flu tablets or Panadeine) at the same time.

Check for double paracetamol – many cold/flu products already contain paracetamol.

Anti-inflammatory medicine – if prescribed, take once daily with food. Do not take other anti-inflammatory medicines such as ibuprofen, naproxen or diclofenac at the same time unless advised. Avoid if you have kidney disease, stomach ulcers/bleeding, or you are on blood thinners, unless approved. Stop and seek advice if you develop indigestion or black stools.

Breakthrough pain medicine – take only if pain is not controlled by the regular medicines above. Common side effects include drowsiness, nausea and constipation. Keep fluids and fibre, and ask a pharmacist or doctor for advice about laxatives.

Driving safety – do not drive or operate machinery if you feel drowsy or impaired. Alcohol increases the risk.

Ice and elevation – apply ice for 15–20 minutes at a time and elevate the leg to reduce swelling.

Seek advice if pain is worsening or not controlled, or you develop fever, increasing redness or swelling, calf pain or swelling, chest pain or shortness of breath.

Start reducing your pain medicines when pain is steadily improving and you do not need breakthrough doses.

Reduce in this order:

1. Stop the breakthrough strong pain medicine first (for example tapentadol/Temgesic).

2. Stop the anti-inflammatory medicine next.

3. Reduce paracetamol last.

If pain flares, step up one level for a day and then reduce again.

If you still need strong pain medicine beyond about 10–14 days, contact your surgeon or GP.

Store medicines out of sight and reach of children. Keep stronger pain medicines in their original packaging. Do not share your medicines.

Do not keep leftover opioid medicines “just in case” – return them to your pharmacy for safe disposal.

Download the pain relief plan (PDF) by clicking the buttons at the top of this page

Related page: https://www.drhalvey.com.au/joint-arthroscopy

Checked 9 March 2026 (private prices). Prices vary by pharmacy and brand.

Prices are product prices and may not include dispensing/service fees. You can ask the pharmacy for the price before the prescription is dispensed.

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Typical medicines prescribed after surgery

• Etoricoxib 120 mg daily for up to 10 days

• If unsuitable: celecoxib or ibuprofen

• Tapentadol or oxycodone only if required for breakthrough pain

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Over-the-counter

• Paracetamol 665 mg modified-release (Panadol Osteo) 96 caplets: about $10.99

• Paracetamol 500 mg (Panamax) 100 tablets: about $4.39

• Ibuprofen lysine 342 mg (Nurofen QuickZorb) 96 tablets: about $26.99

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Prescription anti-inflammatory medicines

• Etoricoxib 120 mg (Arcoxia) 10 tablets: about $43.99

• Celecoxib 200 mg (Celebrex) 30 capsules: about $8.99

We choose the anti-inflammatory that is safe for you (kidneys/stomach/heart/blood thinners), not just the cheapest option.

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Effectiveness snapshot (NNT/impact)

1. Etoricoxib – strongest effect size (lower NNT) but higher cost

2. Ibuprofen (including ibuprofen lysine) – moderate effect

3. Celecoxib – milder effect

We choose the anti-inflammatory that is safe for you (kidneys/stomach/heart/blood thinners), not just the cheapest option.

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Short-course breakthrough pain medicine

These medicines are used only if pain is not controlled by regular paracetamol and an anti-inflammatory.

• Tapentadol immediate-release 50 mg (Palexia) 20 tablets: about $21.99

• Oxycodone 5 mg (Endone/Mayne Oxycodone) 20 tablets: commonly around $9–10 (brand dependent; pharmacy dispensed price varies)

• Hydromorphone 2 mg (Dilaudid) 20 tablets: about $11.99

Schedule 8 (strong pain medicine) notes

• Pharmacies may ask for ID

• Some pharmacies may need to order stock

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Safety

Anti-inflammatory medicines may not be suitable if you have kidney disease, stomach ulcers, certain heart conditions or are taking blood thinners.

Simple explanation

For moderate postoperative pain I commonly prescribe tapentadol rather than traditional opioids such as oxycodone. Tapentadol provides similar pain relief but tends to cause fewer side effects such as nausea, vomiting and constipation.

For many patients this means good pain control with better tolerability after surgery.

Because of this balance between effectiveness and side effects, many hospitals now use tapentadol as the first oral opioid for postoperative pain.

If you would like to understand the reasoning in more detail, you can read further below.

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How tapentadol works

Most traditional opioids work through a single mechanism: stimulation of the opioid (mu) receptor.

Tapentadol works in two ways:

• a mild opioid effect

• activation of the body’s natural pain control system through noradrenaline reuptake inhibition

The second mechanism activates descending pain inhibitory pathways in the spinal cord. These are the same pathways the brain uses to dampen pain signals.

Because of this dual mechanism, tapentadol can achieve effective pain relief without relying entirely on opioid receptor activity.

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Lower “opioid burden”

Because only part of the analgesic effect comes from the opioid receptor, tapentadol exposes the body to a lower overall opioid load compared with traditional opioids providing similar pain relief.

In pain medicine this is sometimes referred to as a lower “mu-load”.

This tends to translate clinically into:

• less nausea

• less vomiting

• less constipation

• improved tolerability

These gastrointestinal side effects are the most common reasons patients struggle with traditional opioids after surgery.

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Safety considerations

Another reason tapentadol is often used first line in hospitals relates to safety.

Studies comparing tapentadol with conventional opioids such as oxycodone have shown similar pain relief but lower rates of gastrointestinal adverse effects. Some experimental data also suggest that respiratory depression may be slightly less pronounced at equivalent analgesic doses.

Tapentadol also has some pharmacological features that improve predictability:

• it has no active metabolites

• it is mainly metabolised by glucuronidation rather than complex liver enzyme pathways

• it has fewer drug interactions than some older opioids

Large post-marketing surveillance programs have also shown relatively low rates of overdose deaths, abuse and diversion compared with some traditional opioids. For this reason it is often considered a safer initial oral opioid option in modern postoperative pain protocols.

It is important to remember that tapentadol is still an opioid medication and must be used carefully and only as prescribed.

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Why hospitals often start with tapentadol

Because tapentadol provides effective pain relief with fewer common side effects and a favourable safety profile, many hospitals now use it as the first oral opioid after surgery.

Stronger conventional opioids such as oxycodone are usually reserved for situations where additional analgesia is required.

This approach aims to provide effective pain control while minimising unnecessary exposure to stronger opioids.

Simple explanation

In addition to tapentadol, I sometimes prescribe a small number of buprenorphine tablets for breakthrough pain after surgery.

Buprenorphine is a strong pain medicine that works well in very small doses. When used under the tongue (sublingually), it can provide effective pain relief that lasts longer than many standard opioid tablets.

It is usually only needed if pain is not adequately controlled by paracetamol, anti-inflammatory medication and tapentadol.

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How buprenorphine works

Buprenorphine is an opioid medication, but it behaves differently from traditional opioids such as morphine or oxycodone.

It binds very strongly to the opioid receptor but activates it in a slightly different way. This means that even very small doses can provide significant pain relief.

Buprenorphine also interacts with several other opioid receptors in the nervous system, including blocking the kappa receptor. This may influence how pain signals are processed and may reduce some forms of opioid-related side effects.

In clinical studies buprenorphine provides pain relief comparable to traditional opioids such as morphine when equivalent doses are used.

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Longer duration of action

One useful property of buprenorphine is that it remains attached to the opioid receptor for longer than most other opioids.

This means that a single dose can often provide longer-lasting analgesia than standard short-acting opioid tablets.

For patients this can translate into:

• longer pain relief

• fewer doses required

• more stable pain control

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Safety profile

Buprenorphine also has several characteristics that make it attractive from a safety perspective.

One important feature is that it shows a “ceiling effect” for respiratory depression at therapeutic doses. This means that beyond a certain point increasing the dose produces little additional respiratory suppression, although analgesia can still increase.

This is different from traditional opioids, where respiratory depression tends to increase in a more linear way as doses increase.

This does not mean buprenorphine is completely risk-free. Like all opioids it can still cause sedation and breathing problems, particularly if combined with other sedating medications such as benzodiazepines, alcohol or sleeping tablets.

However, in many clinical settings it is considered to have a favourable safety profile compared with conventional opioids.

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Lower risk of some opioid complications

Buprenorphine also appears to have a lower tendency to produce some of the problems associated with long-term opioid use.

Research suggests it may:

• produce less opioid-induced hyperalgesia (a paradoxical increase in pain sensitivity)

• cause milder withdrawal symptoms if used for longer periods

• have lower rates of misuse compared with some conventional opioids

These properties are part of the reason buprenorphine is also used internationally for opioid substitution therapy.

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Why I use it as a small “backup” medication

Because buprenorphine is potent and long-acting, only a small number of tablets are usually needed.

In my postoperative prescribing approach it is typically used as a backup option if pain is not controlled with:

• paracetamol

• anti-inflammatory medication

• tapentadol

This layered approach aims to provide effective pain control while minimising the need for higher doses of stronger opioids.

Simple explanation

Oxycodone is a strong opioid pain medication. I generally do not prescribe it routinely after surgery because it has a higher potential for dependence and side effects compared with some other options.

However, I sometimes prescribe a small amount after major joint replacement surgery (such as hip or knee replacement). In this situation the rapid onset of oxycodone can help patients achieve good pain relief quickly before an important physiotherapy session.

Outside of this situation I usually prefer other medications that provide effective pain control with a lower risk profile.

If you would like to understand the reasoning in more detail, you can read further below.

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Rapid onset of pain relief

One of the reasons oxycodone is still used in some situations is its relatively rapid onset when taken orally.

Compared with some other opioid medicines, oxycodone is absorbed quickly and produces a relatively fast analgesic effect. This makes it useful when a patient needs reliable short-term pain relief for a specific activity.

After joint replacement surgery, early mobilisation and physiotherapy are extremely important for recovery. A rapidly acting opioid can sometimes help patients tolerate the first physiotherapy sessions more comfortably.

For this reason oxycodone may occasionally be prescribed in this specific context.

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How oxycodone works

Oxycodone is a traditional opioid medication that works mainly through stimulation of the mu-opioid receptor in the brain and spinal cord.

Unlike tapentadol, which has two mechanisms of action, oxycodone relies almost entirely on this opioid receptor effect.

This is why it can be very effective for pain relief, but it also explains why opioid-type side effects are more prominent.

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Metabolism and variability

Oxycodone is metabolised in the liver through several enzyme systems, mainly CYP3A4 and CYP2D6.

This means that different patients may experience different effects depending on:

• their genetic metabolism profile

• interactions with other medications

• liver function

Some people metabolise oxycodone more rapidly, which can increase both analgesic effect and side effects. Others metabolise it more slowly and may experience reduced analgesia.

These metabolic pathways also mean that some medicines can increase oxycodone levels in the body, which can increase sedation or respiratory depression.

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Safety considerations

Like all opioids, oxycodone can cause side effects such as:

• sedation

• nausea and vomiting

• constipation

• respiratory depression

Another important concern with traditional opioids is the potential for dependence and misuse. Because oxycodone produces a strong opioid effect, it has a higher addiction potential than some newer analgesic options.

For this reason many modern postoperative pain protocols aim to minimise unnecessary exposure to conventional opioids where possible.

In my prescribing approach, oxycodone is therefore usually reserved for specific situations where its rapid onset is particularly useful.

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How this fits into my pain management approach

After most surgical procedures I aim to control pain using a layered approach:

• paracetamol

• anti-inflammatory medication

• tapentadol if stronger pain relief is needed

• buprenorphine as a small backup option

Oxycodone is generally reserved for situations such as joint replacement surgery where a fast-acting opioid may help patients participate in early physiotherapy.

This strategy aims to provide effective pain relief while minimising unnecessary exposure to stronger opioids.