Management of postoperative pain

Abstract

Postoperative pain is the most undesired consequence of surgery, and if not managed adequately, can lead to delayed recovery and increased hospital stay.¹ Surveys continue to reveal that postoperative pain is insufficiently managed throughout the first world, let alone in the Third World.² An American survey over 20 years showed that only one in four patients had adequate relief of postoperative pain. This has led recovery room protocols to include pain as a fifth vital sign that needs to be addressed before patients are discharged to the ward.³ Opioid-sparing techniques are becoming more popular as they decrease the undesired side-effects from narcotic analgesics, especially since data now suggest that some patients who are treated with opioids may have paradoxical reactions, resulting in hyperalgesia, rather than analgesia.^4,5 Treatment of pain has also moved to the preventive realm, and aims to block the afferent nociceptive bombardment of the central nervous system, before and during surgery. This prevents neurochemical changes that could lead to central sensitisation and chronic pain.⁶ The importance of an acute pain service in hospitals has been shown to be invaluable. These teams practise in the recovery room, as well as the wards, to ensure continued analgesia services after discharge from theatre. They also provide valuable information to medical staff on the use of patient controlled analgesia (PCA) systems, epidurals, indwelling nerve catheters, and optimal drug dosing and administration.⁷