Post-Operative Pain Management Flashcards
What can pain be divided into?
Acute and chronic types
In what respects can post-operative pain be assessed?
Subjectively and objectively
How is post-operative pain assessed subjectively?
By asking the patient to grade their pain on a scale of mild, moderate, or severe
What can subjective post-operative pain be assessed as part of?
Regular nursing observations
Why is asking the patient to grade their pain on a scale from 1 to 10 problematic?
Because it requires the patient to quantify their pain into a number, and then the doctor is then required to interpret that into an appropriate analgesia regime
How is pain assessed objectively?
By looking at the clinical features of pain
What are the clinical features of pain?
- Tachycardia
- Tachypnoea
- Hypertension
- Sweating
- Flushing
- Unwillingness to mobilise or agitation in those that are less able to communicate their pain
In what situations should each patient be assessed for pain?
- When mobile
- When taking a deep breath
- When in bed
What does inadequate control of post-operative pain result in?
Slower recovery
Give 2 examples of how poor post-operative pain control can lead to slower recovery?
- Patients with poorly controlled pain are often reluctant to mobilise, in turn resulting in slower restoration of function and rehabilitation capacity
- Patients in pain following abdominal surgery will not breath as deeply as they normally wound, resulting in adequate ventilation and subsequent atelectasis and hospital acquired pneumonia
What is the best known method for approaching pain relief?
The WHO analgesic ladder
What does the WHO analgesic ladder provide?
A strategy for titrating analgesia
What is started with on the WHO analgesic ladder?
Simple analgesics such as paracetamol or NSAIDs
What should be done if simple analgesics are not controlling pain well enough?
Should move up to the next stage of the ladder, and consider prescribing weak opiates, such as codeine or tramadol
What should be done if weak opiates are not controlled pain adequately?
Move up to the next step, and prescribe morphine or other stronger opiates
What can be done if stronger opiates are not sufficient?
Consider alternatives to the oral route, such as topical, intravenous, or subcutaneous
What can be done if parenteral strong opiates fails, and sinister causes of pain have been ruled out?
Consider specialist help and/or a patient-controlled analgesia pump
What might neuropathic pain respond better to?
Alternative analgesics such as amitriptyline or gabapentin
What should be done as patients recover, regarding pain management?
It is important to move down the ladder, and wean down the analgesia to a simple regime
What does non-opioid analgesia consist of?
Paracetamol and/or NSAIDs
Give two examples of NSAIDs
- Diclofenac
- Ibuprofen
How do NSAIDs work?
By inhibiting the synthesis of prostaglandins, thereby reducing the potential inflammatory response causing the pain