Pain is most common complaints of the patient after any surgical procedure. It can be alleviated by different pharmacological and non-pharmacological approaches accordingly.

1. Abiyad Ahmed Anaesthesia & Surgery Allied Health Science Study Material
Post Operative
Pain Management
Presented by, Abiyad Ahmed
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2. • Pain is the most common complaint of surgical patients during and post hospitalization. It is defined as
an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
• Nearly 20% patient experiences severe pain in the first 24h after surgery.
• Pain may be acute, chronic or persistent as surgery causes tissue damage or injury.
• Surgical injury triggers myriad responses in the pain matrix from sensitization of peripheral and central
pain pathways to feeling fear, anxiety or other emotional experiences.
• Pain is experience in different ways influenced by biological, psychological state or traits.
• Pain is multidimensional experience and the etiology is multifactorial. A few causes are discussed:-
• Incisional site pain – Skin or Subcutaneous tissue
• Deep somatic pain – Cutting or coagulation
• Neuropathic pain – injury to the nerve
• Misc. causes – tight dressing, ET tube placement, NG tube or other catheter, needle trauma etc.
Etiology
Introduction

3. Factors influencing PAIN
o Extent of the incision, surgical trauma, type of anaesthesia
o Type and duration of the surgical procedure
o Mental, Physical and Social status
o Age, Sex
Briefing Pathway
Hyperalgesi
a
(sensitivity
to pain)
Inflammation
due to
stimulation of
inflammatory
mediators
Tissue
trauma or
nerve injury
due to
surgery

4. Management
Alleviation of pain and prevention should be first choice of healthcare professionals.
The management and alleviation may be achieved by the following approaches:
 Preassessment
 Pharmacological management
 Non-pharmacological techniques
Preassessment
 Pre-anesthetic counselling
 Discuss about the post-operative pain to alley anxiety
 Unidirectional pain scale
 Premedication to alley anxiety and post-op. amnesia

5. Pharmacological Management
Most analgesics act by inhibiting ascending pain signals, either in periphery or centrally in the spinal cord and brain, and
facilitating descending inhibitory spinal pathways. This leads to decreased nociceptive transmission and interpretation of
these signals as pain by higher neurological centers.
Non-Pharmacological Management
Drugs in use:-
 Opioids
 Non steroidal anti-inflammatory drugs (NSAIDs)
 Local anesthetics
 Epidural / Spinal anesthetics
1.Acupuncture
2.Massage
3.Hypnosis
4.TENS (transcutaneous electric nerve stimulation)

6. 10
min
Drugs
Groups Agents/Drug Comment
Opioids Tramadol Long duration 3-4h; 50-100mg 4hrly* i.v. or i.m. or orally
Fentanyl Rapid onset, 1-1.5h duration, 1-5µg/kg i.v., Spinal – 5-10µg*
Morphine Slow onset, long acting 4-5hours, 2.5-10mg i.v.*
Pethidine
Alpha-2
adrenergic
agonists
Dexmedetomidine More selective and less adverse effects, Hypotenson is the most common side effect.
It can be used for treatment of addiction of opioids and benzodiazepines.
NSAIDs Acetamenophen
(Paracetamol)
Analgesic, Antipyretic, 0.5-1gm tds.*
Ibuprofen Analgesics, Antpyretics, Anti-inflammatory, 600mg qds.*
Aspirin Analgesics, Antpyretics, 1200-1500mg tds.*
Local anesthetics Bupivaccaine Slow onset, long acting, Max. dose 3mg/kg*, Used in spinal, epidural and peripheral nerve block
Lignocaine Rapid onset, Membrane stabilizing action hence used in arrhythmia, dose – 4mg/kg*
Lignocaine with
Adrenaline
Dose – 7mg/kg*
* Doses indicated above are for adults only.

7. 10
min
Must Read books
1. Short Textbook of Anesthesia | Ajay Yadav | 6th Ed.
2. Treatment of opioids Opioid Treatment for Chronic Pain - Made for This Moment (asahq.org)
3. Patients and ICU nurses' perspectives of non-pharmacological interventions for pain
management https://doi.org/10.1111/j.1478-5153.2012.00531.x 03Oct., 2012
4. Oxford Textbook of Anesthesia for Elderly Patient 1st Ed.
5. Basics of Anesthesia Sixth Ed. Elsevier
EVALUATE

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