Post Operative Pain

Management
Introduction:
Pain serves a biological function
In the case of post op, pain is the result of
the surgery
The goal of management is to relief or
eliminate pain and discomfort with a
minimum side effects
Depend on: clinical fx, patien-related fx,
and local fx

Type of surgery
Severity Duration Interventions
Laparotomy

Moderate to severe Days to weeks
Epidural opioids,
Regional.
PCA opioids.
Cholecystectomy Mild to moderate Days
IM/IV opioids and
NSAIDs and PO opioids
Oral medicine (Codeine
preferred because of its
lesser effect on
brain/blood flow)
NSAIDs controversial
PCA - a consideration
but controversial
Nephrectomy Mild to severe Days to weeks
PCA opioids


Type of surgery Severity

Duration Intervention
Histerectomy Mild to severe Weeks
PCA opioids.
IM, IV/PCA, oral opioid or
NSAID often sufficient once
bowel function has returned
Epidural can also be
considered for abdominal
hysterectomy
Prostatectomy Moderat to severe Weeks
Epidural opioid.
IM, IV or PCA opioids,
epidural analgesia may
reduce pain for several
subsequent weeks
postoperative
Herniotomy Mild to severe Weeks
Regional - preferred based on
evidence
PO opioids consensus
Regional anesthesia may
prevent postoperative pain
Opioids combined with
NSAIDS to treat pain