AIMS OF POST-OPERATIVE PAIN MANAGEMENT


The main aim of post-operative pain management is generally to speed up recovery and improve clinical outcomes.1 In order to achieve this, various factors need to be considered. First of all, reduction of pain is an important aspect in the management process. However, effective post-operative pain management goes far beyond simply relieving pain. For example, pain can cause reduced mobility, which, in turn, can lead to complications – both of which may further delay the patient’s discharge from hospital. Furthermore, uncontrolled post-operative pain can have additional effects that impact negatively on the patient’s sleep, mood and other body functions.

In the following sections, we will further specify the importance of improved pain relief, early mobilization and, following on from this, a reduced risk of complications and clarify how this can lead to earlier discharge and improved clinical outcomes.

 

Aims of post-operative pain management

 

Improved pain relief
 

  • The top three causes for delayed discharge after ambulatory surgery are pain, drowsiness and nausea/vomiting.2
     
  • Consequently, pain relief needs to be improved, in order to achieve timely or early discharge.

 

Early mobilisation
 

  • According to the NHS, early mobilisation is one of the four elements of an enhanced recovery programme:3
     
    1. Pre-operative assessment, planning and preparation before admission
       
    2. Reducing the physical stress of the operation
       
    3. A structured approach to immediate post-operative and peri-operative management, including pain relief
       
    4. Early mobilisation
       
  • The impact that early mobilization can have on the length of hospital stay is demonstrated nicely in the following study:

 

Impact of fast track rehabilitation

 

Reduced risk of complications
 

  • There are a number of complications that may arise from sub-optimally treated post-operative pain.  An overview of possible complications is provided in the following table.
     
    Cardiovascular e.g. tachycardia, hypertension, myocardial ischemia, deep-vein thrombosis (DVT), pulmonary embolism (PE)
    Respiratory e.g. atelectasis, decreased cough, sputum retention, pneumonia or other infections
    Gastrointestinal e.g. decreased gastric and bowel motility, ileus (blockage)
    Genitourinary e.g. urinary retention
    Neuroendocrine/metabolic e.g. increased catabolic hormones, reduced anabolic hormones
    Musculoskeletal e.g. muscle spasm, immobility, muscle wastage
    Central nervous system e.g. chronic pain due to central sensitisation
    Phsychological e.g. anxiety, fear, sleep deprivation

     
  • Consequently, an optimal post-operative pain treatment and early mobilization help to avoid these risks

 

References

1 American Society of Anesthesiologists (ASA). Anesthesiology. 2012.
2 Vadivelu N, Mitra S and Narayan D. Yale J Biol Med. 2010; 83: 11-25.
3 National Health Service (NHS). Enhanced Recovery Programme. Available at: http://www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/enhanced_recovery_programme.html. Accessed 9 September 2015.
4 den Hertog A, Gliesche K, Timm J, et al. Arch Orthop Trauma Surg. 2012; 132: 1153-63.
5 Mcintyre PE and Schug SA. Acute Pain Management. A practical guide. 4th ed. Waretown, NJ: Apple Academic Press Inc. 2015.