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Post operative Pain Management Power Point Presentation

Post operative Pain Management Power Point Presentation

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Published by: drschethan on Nov 07, 2010
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Postoperative Pain Management

Dr. Chethan.S

Pain management is a humanitarian act

y y y y

medical -rapid recovery, reduces morbidity economic -early discharge from hospital Improves quality of life for the patient Facilitate rapid recovery and return to full function

Definition :
According to the International Association for the Study of Pain (IASP), pain is defined as


"An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.´

(IASP 1979)

Physiology of Pain

Individual variation in response to pain:
genetic makeup y cultural background y Gender y Paediatric y Geriatric

Special groups:
y y y y y y

Depression, Anxiety, Neuroticism Pre existing pain problems Pre-Operative use of opioids Pseudo-addiction Opioid induced hyperalgesia Patients with difficulty in communicating *young age *due to critical illness, *cognitive impairment, *language barriers

Positive role of pain:

Draws attention of the patient who will alert the healthcare provider Provides a warning of tissue damage Induces immobilisation to allow appropriate healing Allows to monitor response of the treatment




Negative effects of pain
Emotional & physical suffering Increased oxygen consumption Impaired bowel movement Cardiovascular side effects Sleep disturbance

Delays mobilisation ² risk of Thromboembolism

Assessment of pain
Assess pain

at rest & on movement to evaluate functional status

Monitor response to Rx y Before & After admn of Analgesic y pain is intense -evaluate, treat, and re-evaluate every 15 min initially in Post Anaesthesia Care Unit (PACU), then every 1-2 h
y y

In the surgical ward, evaluate, treat, and re-evaluate regularly every 4-8 h Intervention threshold: Define the maximum pain score above which pain relief is offered Document Pain & response to treatment, including adverse effects in the vital sign sheet


Patients who have difficulty

patients who are cognitively impaired severely emotionally disturbed Children patients who do not speak the local language patients whose level of education or cultural background differs significantly from that of their health care team





Also consider:
y y y y

Unexpected intense pain, Altered vital signs New diagnoses, such as wound dehiscence, infection, or deep venous thrombosis

Immediate pain relief without asking for a pain
rating is given to patients in obvious pain who are not sufficiently focused to use a pain rating scale. y

Family members are involved when appropriate

Tools for pain assessment

Patient Education
y y y y y y y y y y y

The procedure Brochures, posters, web pages, videos Anaesthesia Post operative pain management education Any previous procedure, experience Available options and rationale Pain assessment tool Pain above which analgesic administration is considered To avoid exaggerating pain Pharmacological Non-pharmacological methods


PAIN Chart

Records time
Informs Doctor if Pain Increases -analgesic admn -extra analgesics given

Paediatric analgesia
Symptoms of pain in children: Physiological:
y y y y

Increased blood pressure Increased heart rate Sweating Reduced oxygen saturation

y y

Crying Restlessness

Education for children·s parents:
y y

A booklet Illness, procedure planned type of anaesthesia Surgical outcomes possible complications management Pain following surgery Analgesics Regional anaesthesia



# after surgery a Questionnaire

Assessment of pain in children VASVAS- for 5-6yrs 5Younger children- behavioural scale children-

PrePre-emptive & Preventive analgesia
Pre-emptive analgesia is admn of analgesic just before insision so that there is analgesia at the time of incision y However studies have shown Preventive analgesia has shown better effect than pre-emptive


Sequential analgesia Management of the Insensate limb Avoiding risk factors for *Thromboembolism *Depression *Dependance



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