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05 December 2008

Pain relief after surgery

Pain causes great discomfort and can be harmful to the patient. It is therefore important to ensure pain relief postoperatively and to continue as long as the patient needs it.

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Pain relief today
Four decades ago, 60% of patients reported that they are dissatisfied with their postoperative pain. Today, the figure remains the same, in spite of development in the field of pain relief, new medication and ways of administering drugs.

Pain is unpleasant and can be harmful to the patient. The medical professional therefore does its utmost to relieve pain after surgery. Nowadays, pain relief is regarded as a basic human right, making it morally and ethically unacceptable not to receive adequate analgesia after surgery.

What are the advantages of good postoperative pain relief?

Patients' comfort Patients who receive pain killers have less pain and feel better.
Improved postoperative mobility, leading to improved recovery and decreased hospital stay A patient is pain free if he or she can move around and cough without experiencing pain. Patients who have undergone a thoracotomy, for example, can be kept almost pain free with epidural analgesia. They can have physiotherapy comfortably and be mobilised into a chair one day or less after the surgery.
Improved respiratory function Effective pain relief can improve breathing and coughing with less risk for retention of secretions, development of complications such as pneumonia and less risk for hypoxia.
Decreased risk for cardiac complications As blood pressure and heart rate increase as a result of pain, oxygen consumption in the myocardium is increased. There is often also a decrease in oxygen supply due to poor respiratory function. Poor postoperative pain control can lead to a myocardial infarct.
Decreased risk for deep venous thrombosis (DVT) The risk for DVT after procedures such as hip or prostate surgery is less if the patient receives epidural analgesia. The frequency of postoperative clotting of vascular grafts is also less.
Improved gastro-intestinal function with earlier gut motility and earlier feeding Patients who have epidural analgesia after major abdominal surgery can be fed a liquid diet the day after surgery.
Decrease in general stress response Decreased stress response has many advantages, including better wound healing and less risk of infection.
Decreased incidence in chronic pain Poorly treated acute pain can lead to chronic pain. It is better to prevent chronic pain as it is difficult to treat and can incapacitate the patient for years.

Good postoperative pain relief improves patients’ satisfaction, comfort and recovery. It also decreases morbidity and duration of hospital stay. Remember that nobody is pain free unless they can move or cough and be pain free.

In addition to pain treatment, other important aspects of postoperative recovery include:

  • attenuation of the peri-operative stress response

  • early mobilisation

  • enteral nutrition

  • prevention and treatment of nausea and vomiting

How long should postoperative pain relief continue?
Many doctors discontinue pain relief prematurely. It is important to continue pain relief as long as the patient needs it.

Many procedures such as joint replacements and thoracotomies still cause severe pain after the first postoperative day. The pain can become excruciating when patients have to have physiotherapy after a procedure.

Expected duration of severe postoperative pain after different types of surgery
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Type of surgery Severe postoperative pain
Lower abdominal surgery

Major joint surgery

Osteotomies

Maxillofacial surgery

Perineal surgery

Two to three days
Thoracotomies

Upper abdominal surgery

Three to four days

Pain: Keep the patient in mind, not just the statistic!
Pain relief requirements can vary greatly from one individual to another, and even in the same individual from one time to another.

Side-effects also vary from person to person. The prescription therefore needs to be tailor-made to benefit the patient.

Read more:
Fix that back pain
Chairs, phones and other enemies of your back

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

 
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