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Post-operative pain

It is important to manage post-operative pain.

One of the most obvious problems a person has to deal with after surgery is pain. There are many reasons why it is important to treat pain after surgery adequately and promptly.

When pain is treated effectively after surgery:

  • The patient is more comfortable and positive
  • They can be mobile and move around sooner
  • Wounds heal better
  • There is less risk for heart and lung complications (like heart attack, pneumonia or hypertension)
  • There is less risk for deep vein thrombosis (This occurs when a blood clot forms in a one of the deep veins of the body, often in a leg vein, and leads to swelling and pain. In some cases, the clot can travel to more vital organs and become life-threatening.)
  • Patients can recover faster
  • Patients are less likely to develop neuropathic pain.

Treating post-operative pain

When choosing options for pain management after surgery, healthcare professionals aim to use the most effective treatments while keeping side effects to a minimum. They have discovered that no single treatment can be considered the best. The most helpful strategy is to use a combination of drugs and techniques to give patients with post-operative pain some relief. For instance, drugs that work in different ways may be combined to produce greater pain relief than either drug alone and possibly fewer side effects. Doctors may also choose different analgesic drugs and techniques according to the type of surgery or procedure.

These are some of the medicines and methods used for post-operative pain control:

  • Opioids. Opioids are a mainstay in treating post-operative pain. These medicines are some of the oldest known to humankind. Opioids can be given by mouth, as a patch applied to the skin, by injection or rectally. Used appropriately, opioids can be very effective for post-operative pain control. Like all medications, opioids have side effects. Common opioid side effects may include constipation, drowsiness and nausea, but these can usually be managed by the healthcare team.
  • Non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs are also used for post-operative pain. They may be given by mouth or by injection. These drugs are usually used after surgeries that are minimally invasive, like for keyhole surgeries (where only a small tube with a camera is used) or those that do not involve large cuts. Side effects associated with NSAIDs may include ulcers and bleeding from the stomach or intestines, so some patients cannot use these medications. Paracetamol, ibuprofen and ketorolac are some examples of NSAIDs.
  • Cyclooxygenase (COX)-2 inhibitors. COX-2 inhibitors treat pain the same way as NSAIDs but may have different side effects to those typically associated with NSAIDs. Examples include celecoxib and etoricoxib.
  • Patient-controlled analgesia (PCA). In conscious patients after surgery, pain medicine can be given via PCA. With PCA, patients can control how much analgesic they get based on their level of pain. The medicine is dispensed by a pump which is connected to an IV line/catheter inserted into a vein, usually in the arm. This allows the patient to have some control over their pain control, without the need to call for a nurse or caregiver to administer the medication.
  • Other kinds of anesthesia. Epidural and spinal analgesia are used for pain relief in some post-operative patients. Medicines given through these routes may be helpful in reducing pain in some cases, but they have side effects that require careful monitoring. Nerve blocks and local anesthesia are some other ways to reduce pain after surgery. Glucocorticoids (steroids) may also be used for pain management.
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