Postoperative pain management
Severe pain from a large incision in a frail patient may require high doses of intravenous opiate drugs leading to elective postoperative endotracheal intubation and ventilation until the patient is stable. This approach should be used if the patient is likely to become hypoxic through struggling in pain if other methods of pain relief are not effective. Other methods of pain relief, properly used, can usually prevent the need for mechanical ventilation even in very major thoracic and abdominal surgery. Acute pain relief teams, using continuous methods of pain relief in high dependency areas well equipped with monitoring, are becoming a routine feature of the postoperative care in both the USA and the UK. Regular intramuscular morphine injection, supplemented by anti-inflammatory analgesic drugs and, possibly, a regional anaesthetic block, are effective treatment for the majority of surgical patients. Each patient should have a pain relief measurement chart for regular assessment with other routine nursing observations. Special methods of pain relief used under close supervision are:
• continuous epidural anaesthesia with opiate or local anaesthetic drugs;
• continuous intravenous opiate analgesia;
• patient controlled analgesia by injection intravenously or epidurally of opioid analgesia. The patient is trained to give a bolus dose of drug by pressing a control button on a machine whose functions have been regulated by the medical staff. The strength, frequency and total dose of drug in a given time are all limited by computer.
Effective postoperative pain relief encourages early mobilisation and hospital discharge.
Simple analgesic agents
In minor surgery, and when the patient is able to eat after major surgery, aspirin and paracetamol are often the only drugs necessary to control pain. Fear of metabolic acidosis and Reye’s syndrome of hepatotoxicity in children have made paracetamol a preferable drug to aspirin in the younger age group. Codeine phosphate is the analgesic favoured after intracranial surgery because it does not have a powerful respiratory depressant effect; it may never be given intravenously as it causes profound hypotension on intravenous injection. Patients with a tendency to peptic ulceration may need cover with omeprazole or misoprostol during analgesic treatment with anti-inflammatory agents.
No comments yet.