Management of Acute Post-Surgical Pain 1

By Dr. Vasanthi Pinto and Dr. Ravi Weerakoon

 

Introduction

          The effective relief of pain is of paramount importance for any patient undergoing surgery. Patients are liable to suffer deep and superficial somatic pain postoperatively and the relief of such excruciating pain would offer them comfort and a better quality of life.

 

Why is the Relief of Postoperative Pain Important?

It is inhuman to allow patients to suffer postoperative pain when pain relief is within easy reach.

The inability to cough due to pain may be a causative factor of lung atelectasis and pneumonia which can later lead to septicemia.

Pain can result in increased sympathetic response in the body with the possibility of increased heart rate, cardiac work and oxygen consumption which can be particularly detrimental to patients who suffer from cardiac instability.

Reduced and restricted body movements due to unrelieved pain can lead to venous stasis with an increased risk of deep vein thrombosis and pulmonary embolism.

The compromised gut motility may lead to postoperative ileus, nausea and vomiting.

Urinary retention can cause reduced urinary tract motility which may be a predisposing factor to infections.

It can lead to increased chances of having chronic pain syndrome.

 

How can Acute Pain and Pain Relief be Assessed?

     The assessment of pain is achieved using pain rating scales. Measurement using these scales is very simple and it helps to gauge the pain the patient is experiencing. Either words or numbers are used to rate the experience of pain.

     Following scales are commonly in use.

 

Simple five point scale

 

 

Numerical Rating Scale

     This is a simple numerical rating scale that allows choosing a number from 0 to 10 that represents the experience of pain.

Visual Analogue Scale

     The Visual Analogue Scale (VAS) consists of a 10cm line, with words at each end denoting the extremes of what is being measured.

 

 

 

Verbal Rating Scale

     The Verbal Rating Scale (VRS) consists of a list of adjectives describing different levels of pain intensity such as burning pain, sharp pain, tearing and aching pain.

     The assessments must be made at regular intervals and should be a part and parcel of the routine postoperative observation. This scale can also be used to measure the effectiveness of pain relief techniques.

 

Mechanism of Pain, Pain Pathways and Analgesic Plan

     There are four processes that precipitate pain. These are transduction, transmission, modulation, and perception.  All these four processes have to be considered when planning pain relief.

 

 

 

 

 

Figure 1: An illustration to show, how different drugs and technique can be used to tackle pain at different places of pain pathway