Postoperative Pain - An Overview

Introduction:

It is essential to control postoperative pain, as it helps in the patient's recovery phase to get back to normal activities. It also allows the patient to adapt psychologically to the postoperative limitations. In the earlier days, opioids were used to control postoperative pain, but various new measures were taken due to their side effects and complications.

It also reduces other complications like blood clot formation post-surgically. Postoperative pain is not only at the site of surgery but also in other areas like muscles, joints, when you move, and throat soreness. There are pharmacological and non-pharmacological methods to control it. Certain preoperative measures should be taken to control postoperative pain, reduce pain and stress, control preoperative medications, educate the patient and the patient's family, etc.

How is Pain Assessment Done Preoperatively?

Postoperative pain can be assessed using various pain assessment scales VAS (Visual analog scale). This scale is used to assess pain after surgery(postoperative pain). It is scored from zero to ten, where zero denotes no pain and ten denotes severe pain.

What Are the Different Methods to Control Postoperative Pain?

1) Pharmacological Methods.

2) Non-pharmacological Methods.

What Are the Pharmacological Techniques for Controlling Postoperative Pain?

• NSAIDs: Nonsteroidal Anti-inflammatory drugs like ibuprofen, and celecoxib, are used as primary treatment for pain control, but bleeding, stomach upset, and dizziness are the side effects of these drugs.

• Opioids - Like morphine, are used post-surgically, for example, morphine. It has side effects such as nausea and stomach upset, but prolonged usage of opioids causes abuse and addiction. This is the main side effect that limits the usage of opioids.

• Other Non-Opioids Painkillers Include - Acetaminophen is a centrally acting pain killer but does not have anti-inflammatory properties; used in acute pain relief-paracetamol is an IV (Intravenous) form of acetaminophen now available, does not have the side effect of affecting platelet functions so can be used in patients with peptic ulcer.

• When a parenteral route of administration is needed, intravenous PCA, called patient-controlled analgesia, is used. In this method, equipment is required, such as a computerized pump in which a button is also provided, so the patient has control over the medicine dosage given; it gives pain relief in most conditions.

• Epidural and Spinalanalgesia- Neuraxial nerve block is used with or without the addition of IV opioid medications. It is mainly used in pelvic, abdominal, and thoracic surgeries, cesareans, and surgeries on the hip. In epidural anesthesia, a catheter is inserted into the epidural space, and medicine is slowly infused into the site (infused drug may be local anesthesia along with opioids). Epidural can be given continuously or as patient-controlled analgesia. This technique is beneficial in risk-category patients such as cardiac patients. In this technique, placing a catheter is not a very painful procedure. Local anesthesia is given by inserting a needle into the epidural space, and through this needle, a catheter is placed into the epidural space. Then the needle is removed, so this catheter slowly infuses medicines. This will provide pain control or anesthesia by keeping the patient awake.

• Peripheral Nerve Block-It includes local, intra-articular, and topical anesthesia. This technique is used in anesthetizing a particular area, thus controlling pain.

• Regional Anesthetic Techniques- This anesthesia is given based on the procedure type. This technique is done under ultrasonic guidance and used for fascial plane blocks.

What Are the Non-pharmacological Techniques for Controlling Postoperative Pain?

This includes various physiological factors which help physical and mental health and thus reduce pain perception without using medicines.

1. Hot or Cold Therapy - In this technique, under doctors' guidance, applying heat or cold over a part of the body performed to control pain

2. Guided Relaxation - In this technique, with the help of calming music or images, the patient is calmed down, and pain perception is reduced.

3. TENS (Transcutaneous Electrical Nerve Stimulation).

• It uses low-voltage electric current to treat the pain.

• It treats chronic pelvic pain, tendinitis, osteoarthritis, etc.

• In this technique, a battery-operated device will transmit current through electrodes. These electrodes are placed over the trigger points, and the current is passed. It will alter the brain's perception of pain, thus reducing the perception of pain.

Clinical Significance:

• It is needed to control postoperative pain, and it reduces the patient's suffering and discomfort. The patient can return to their daily activities early. It keeps the patient motivated, and most importantly. If this postoperative pain is left untreated, it may change into chronic pain.

• The doctor can assess the patient's ability to manage pain through proper history taking, a doctor can assess the patient's current health condition and drug allergies, and accordingly, he can plan the procedure and thus will be able to control postoperative pain.

• The use of opioids-opioids is effective in controlling postoperative pain, but their side effects should be considered while taken. Overdose can even cause death or disability.

Complications:

• Postoperative pain will limit the movement and daily activities of the patient. Thus it affects the patient both physically and mentally if the patient is unable to sleep and do their routine activity that may affect their whole health.

• When NSAIDs are administered, apart from their normal side effects like nausea, vomiting, and gastric irritation, they may induce bleeding, which may cause blood loss in patients and patients who have surgeries with a vascular-rich area like tonsil removal surgery. These drugs may worsen the condition. It also causes an ailment in the renal system and bleeding in the gastrointestinal system.

• Opioids, when taken to control pain, also cause nausea, vomiting, gastrointestinal irritability, and irritation sensation. Overdose of opioids can even cause death or disability. Prolonged usage of these drugs causes abuse and addiction. When this group of drugs is withdrawn early, it causes anxiety, restlessness, insomnia, etc.

• When giving epidural or spinal anesthesia, patients should be closely monitored because there are chances of hypotension and respiratory depression.

Conclusion:

Each patient is different, so their perception of the pain will be. Thus for each patient, a thorough medical history should be taken. It helps to know the allergy to drugs, systemic disease, pain perception, and history of drug abuse or side effects. This gives a guideline for perioperative and postoperative pain control. Effective control of postoperative pain is a key factor in the success of the whole treatment procedure.