Management of postoperative pain

INTRODUCTION

Management of postoperative pain relieves suffering and leads to earlier mobilization, shortened hospital stay, reduced hospital costs, and increased patient satisfaction [1-3]. Pain control regimens should not be standardized; rather, they are tailored to the needs of the individual patient, taking into account medical, psychological, and physical condition; age; level of fear or anxiety; surgical procedure; personal preference; and response to agents given.

The major goal in the management of postoperative pain is minimizing the dose of medications to lessen side effects while still providing adequate analgesia. This goal is best accomplished with multimodal and preemptive analgesia [4].

A multidisciplinary team approach (eg, acute pain service) is useful for formulating a plan for pain relief, particularly in complicated patients, such as those who have undergone extensive surgery, chronically use narcotics, or have medical comorbidities that could increase their risk of analgesia-related complications or side effects.

This topic discusses the management of acute surgical pain. The management of chronic pain is discussed elsewhere. (See "Evaluation of chronic pain in adults" and "Overview of the treatment of chronic pain".)

SURGICAL PAIN MECHANISM

Surgical pain is due to inflammation from tissue trauma (ie, surgical incision, dissection, burns) or direct nerve injury (ie, nerve transection, stretching, or compression) (figure 1) [5]. The patient senses pain through the afferent pain pathway (figure 2), which can be altered by various pharmacologic agents.

                                 

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Literature review current through: Aug 2014. | This topic last updated: May 12, 2014.
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