Pain Centre

05 December 2008

Advantages of postoperative pain relief

There are several advantages of postoperative pain relief.

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Comfort
Having pain is not pleasant. Anybody who has undergone a major operation can testify to the value of good pain relief. Simply put: patients who receive painkillers have less pain and feel better!

Better mobility, better recovery, shorter stay in hospital
Being pain free not only means not having pain when you lie completely still in your bed, but also not having pain when you move, cough, or during the physiotherapy sessions! Many studies have proven that these patients have a quicker recovery, shorter hospital stays, and function better even several months after the surgery (e.g. after major orthopaedic surgery)

Better breathing
Surgery on the abdomen and the chest wall can be extremely painful post-operatively, especially when breathing or coughing. Poor breathing can lead to too little oxygen intake, and if secretions cannot be coughed up, especially in smokers, it can result in serious pneumonia. This can be disastrous for e.g. obese, elderly or chronically sick patients.

Less strain on the heart
Pain can increase your blood pressure and heart rate, which puts strain on the heart. This usually will not matter for a healthy heart, but for the less healthy ones this can lead to a heart attack!

Less risk for formation of blood clots in the vessels and the lungs
Major surgery can cause the body to form blood clots in the veins (deep venous thrombosis – DVT), which can shoot up to the lungs and be fatal (pulmonary embolism). Efficient regional anaesthesia, like an epidural, decreases this risk by about 20%. Together with other preventive measures like elastic stockings and certain drugs, it drastically reduces the risk for this possible fatal complication.

Earlier feeding
After abdominal surgery, the patient traditionally was not allowed to eat for many days. This has changed thanks to epidural pain relief post-operatively: the epidural itself makes the bowel restart its normal activity earlier, and the good pain relief it provides precludes the use of morphine or other opioids. Opioids have a paralysing effect on the bowel, and can make you feel nauseous.

Epidural analgesia makes it possible to eat even on the day after the surgery. This does not mean you are going to have steak and chips and cheesecake of course: the surgeon will prescribe a special nutritional drink specifically designed for this purpose, which not only feeds you, but also heals the gut (the gut itself also needs nutrition).

Decrease in general stress response
Surgery subjects your body to a lot of stress. With this is not meant the stress that spoken about in daily life, like living in a hectic world, sitting in traffic jams, being yelled at by an irritating boss etc. What is meant here is physiological stress: pain, cooling during surgery, blood loss etc. If all these stressing factors are treated appropriately, the challenge (“stress”) to the body will be much less, allowing for a speedier and less complicated recovery. For example: the stress of pain increases your heart rate and blood pressure, and in a person with heart disease, this can lead to a heart attack.

Decreased incidence in chronic pain
Poorly treated pain after surgery can sometimes become chronic (lasting several months or years). This has been described for chest surgery, but might also be true for other types of surgery.

Read more:
Heart Attack
Meds & You

Links:
Arthritis Foundation of South Africa
Multiple Sclerosis South Africa
The South African Society of Physiotherapy

 

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Dr Raath originally specialised and worked as an anaesthesiologist in private practice. In 2008 he obtained his Fellowship In Interventional Pain Practice and since then has operated the the Pain Clinic at the Netcare Jakaranda Hospital in Pretoria which treats all forms of chronic pain. Read more here.

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