PostoperativePostoperativePain ManagementPain 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 PainPhysiology of Pain

Individual variation in Individual variation in response to pain:response to pain:

genetic makeupcultural backgroundGenderPaediatricGeriatric

 

Special groups:Special groups:

Depression, Anxiety, NeuroticismPre existing pain problemsPre-Operative use of opioidsPseudo-addictionOpioid induced hyperalgesiaPatients 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 painNegative effects of painEmotional & physical suffering

Increased oxygen consumptionImpaired bowel movement

Delays mobilisation – risk of Thrombo-embolism

Sleep disturbance

Cardiovascular side effects

Assessment of painAssessment of painAssess 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 difficultyPatients 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:Also consider:Unexpected intense pain, Altered vital signsNew diagnoses, such as wound

dehiscence, infection, or deepvenous 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 assessmentTools for pain assessment

Patient EducationPatient EducationThe procedureBrochures, posters, web pages, videosAnaesthesia Post operative pain management educationAny previous procedure, experienceAvailable options and rationalePain assessment toolPain above which analgesic administration is

consideredTo avoid exaggerating painPharmacologicalNon-pharmacological methods

VITALSChart

PAINChart

Records time-analgesic admn-extra analgesics given

Informs Doctor if Pain Increases

Paediatric analgesiaPaediatric analgesia

Symptoms of pain in children: 

Physiological:Increased blood pressureIncreased heart rateSweatingReduced oxygen saturation

Behavioural:CryingRestlessness

Education for children’s Education for children’s parents: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 childrenAssessment of pain in childrenVAS- for 5-6yrsVAS- for 5-6yrs

Younger children- behavioural scaleYounger children- behavioural scale

Pre-emptive & Preventive Pre-emptive & Preventive analgesiaanalgesiaPre-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