Postoperative Pain

27th November 2006 at 09:26 GMT by Dr.C.A.Jenner MB BS, FRCA. Permalink.

Article on the clinical features and treatment of Postoperative Pain

Introduction

The management of postoperative pain is one of the principal missions of the pain management specialists.

Characteristics of postoperative pain

Postoperative pain can be easily distinguished from other forms of pain. A few peculiar characteristics of postoperative pain include:

• Constant, surgically related pain, often described as aching in nature, near the point of surgery.
• Acute exacerbation of pain added to the basal pain, due to activities such as coughing, getting out of bed, physiotherapy and dressing changes.
• Progressive improvement in the pain over a short period of time.

Effects of postoperative pain

Postoperative pain can generally affect all organ systems. These include:

• Respiratory
• Cardiovascular
• Gastrointestinal
• Genitourinary
• Neuroendocrine
• Muscoskeletal
• Psychological

Techniques of Postoperative Pain Management

The goal for postoperative pain management is to reduce or eliminate pain and discomfort with a minimum of side effects. Postoperative pain relief must reflect the needs of each patient. Many factors need to be taken into account while developing this kind of a pain relief program, such as clinical and patient-related factors.

Here we briefly discuss the various techniques and options for postoperative pain management.

A) Non-pharmacologic management

• Cognitive Modalities: This includes distraction, relaxation and biofeedback. Hypnosis is also a major technique employed.
• Physical modalities: This involves cold and heat therapies, exercise, positioning, immobilization, massage and acupuncture. These techniques are often supplemented by the Transcutaneous Electrical Nerve Stimulation (TENS)

B) Pharmacologic Management

Many of pharmacologic treatments and medications involved in postoperative pain management include:

• Oral medication
• Intravenously administered
• Epidurals
• Spinal injections
• Opioids
• Acetaminophen
• NSAIDs
• Local anesthetics
• Glucocorticoids

C) Patient Education

• General postoperative management
• Discharge education
• Epidural education

In addition, the site of surgery has a profound effect upon the degree of postoperative pain and the techniques involved. Operations on the thorax and upper abdomen are more painful than operations on the lower abdomen. On the other hand, the peripheral operations on the limbs are comparatively less painful than the either of them.

Importance of postoperative pain management

Poor management of postoperative pain has been linked to a reduced quality of life. It is also known to interfere with physical therapy. The consequences of inadequate postoperative pain management also have negative impact on the safety and satisfaction of the patient concerned.

Such consequences not only imply reduced patient satisfaction but also severe economic burden that is reflected in the extended length of hospital stays for the treatment of uncontrolled postoperative pain.

Conclusion

There needs to be an increased awareness and initiatives need to be taken for development of better management programs for postoperative pain. Better results are sure to be achieved if different perspectives are explored and new techniques are invented towards this end.