Postoperative

Pain Management

Dr. Chethan.S
Pain management is
a humanitarian act
Benefits:

medical -rapid recovery, reduces morbidity

economic -early discharge from hospital

Improves quality of life for the patient

Facilitate rapid recovery and return to full

function
Definition :

According to the International Association for the Study of Pain

(IASP), pain is defined as

"An unpleasant sensory and emotional

experience associated with actual or potential
tissue damage, or described in terms of such
damage.“
(IASP 1979)
Physiology of Pain
Individual variation in response to
pain:
genetic makeup
cultural background
Gender
Paediatric
Geriatric

 
Special groups:
 Depression, Anxiety, Neuroticism
 Pre existing pain problems
 Pre-Operative use of opioids
 Pseudo-addiction
 Opioid induced hyperalgesia
 Patients with difficulty in communicating

*young age
*due to critical illness,
*cognitive impairment,
*language barriers
Positive role of pain:

 Draws attention of the patient who will alert the

healthcare provider

 Provides a warning of tissue damage

 Induces immobilisation to allow appropriate healing

 Allows to monitor response of the treatment

 Negative effects of pain
Emotional
& physical Sleep
suffering disturbance
Increased
oxygen
consumption
Cardiovascular
Impaired side effects
bowel
movement

Delays
mobilisation
– risk of
Thrombo-
embolism
Assessment of pain
Assess pain
 at rest & on movement to evaluate functional status

Monitor response to Rx
 Before & After admn of Analgesic 
 pain is intense -evaluate, treat, and re-evaluate
every 15 min initially in Post Anaesthesia Care Unit (PACU),
then every 1-2 h

 In the surgical ward, evaluate, treat, and re-evaluate regularly

every 4-8 h
 Intervention threshold:
Define the maximum pain score above which pain relief is offered

 Document Pain & response to treatment,

including adverse effects in the vital sign sheet
Patients who have difficulty
 patients who are cognitively impaired

 severely emotionally disturbed

 Children

 patients who do not speak the local language

 patients whose level of education or cultural background

differs significantly from that of their health care team
Also consider:
 Unexpected intense pain,
 Altered vital signs
 New diagnoses, such as wound dehiscence,
infection, or deep
 venous thrombosis

Immediate pain relief without asking for a pain

rating is given to patients in obvious pain who are not
sufficiently focused to use a pain rating scale.

Family members are involved when

appropriate
Tools for pain assessment
 Patient Education
 The procedure
 Brochures, posters, web pages, videos
 Anaesthesia 
 Post operative pain management education
 Any previous procedure, experience
 Available options and rationale
 Pain assessment tool
 Pain above which analgesic administration is considered
 To avoid exaggerating pain
 Pharmacological
 Non-pharmacological methods
VITAL
S
Chart
PAIN
Chart

Records time
-analgesic admn
Informs Doctor if Pain -extra analgesics given
Increases
Paediatric analgesia
Symptoms of pain in children: 

Physiological:
Increased blood pressure
Increased heart rate
Sweating
Reduced oxygen saturation

Behavioural:
Crying
Restlessness
Education for children’s parents:
 A booklet
 Illness, procedure planned
type of anaesthesia

 Surgical outcomes
possible complications
management

 Pain following surgery

Analgesics
Regional anaesthesia

# after surgery a Questionnaire

Assessment of pain in children
VAS- for 5-6yrs

Younger children- behavioural scale

Pre-emptive & Preventive analgesia
Pre-emptive analgesia is admn of
analgesic just before insision so that there
is analgesia at the time of incision
However studies have shown Preventive
analgesia has shown better effect than
pre-emptive
Sequential analgesia

Management of the Insensate limb

Avoiding risk factors for

*Thromboembolism
*Depression
*Dependance