【Health Lecture】Take you to understand the pain after surgery

In order to ensure the scientific effect of learning health knowledge in the 3rd China Elderly Health Knowledge Competition, the organizers have collected various health science articles suitable for elderly people to learn from various hospitals. We will share them through the "Health Lecture Hall" column. Today, Yuan Fangfang, an anesthesia nurse in the operating room of Baoding Second Central Hospital, brought us a related science article about postoperative pain. Elderly friends are welcome to learn.

Many surgical patients are worried about postoperative pain. Do I need an analgesic pump? Will I really not feel any pain after installing an analgesic pump? In response to these questions, today I will share with you some popular science questions about postoperative pain.

The treatment of perioperative pain, especially acute postoperative pain, is an important part of clinical anesthesia. Perfect postoperative pain treatment is of great significance to improving the quality of life of postoperative patients.

What is the impact of postoperative pain on patients?

Postoperative pain is an acute pain that is mainly noxious and can cause a strong stress response in the body, accompanied by an unpleasant sensation and emotional feeling caused by tissue damage.

What are the short-term adverse effects of pain?

① Pain can lead to sympathetic nerve excitement, increase oxygen consumption, and have adverse effects on ischemic organs.

② Pain can cause increased heart rate, vasoconstriction, increased blood pressure, and increased myocardial oxygen consumption, which increases the risk of myocardial ischemia, myocardial infarction, and stroke.

③ Postoperative pain in the upper abdomen and chest can inhibit breathing, causing shallow and rapid breathing, reduced ventilation, and inability to cough and expectorate forcefully, leading to postoperative lung complications.

④ Pain can reduce gastrointestinal motility and delay the recovery of gastrointestinal function.

⑤ Pain weakens the movement of urethra and bladder muscles, causing urinary retention.

⑥ Due to pain, increased muscle tension and muscle spasms, body activities are restricted; deep vein thrombosis and even pulmonary embolism are triggered.

⑦ Pain can also lead to an enhanced neuroendocrine stress response, triggering a postoperative hypercoagulable state and immune inflammatory response, resulting in a decrease in the patient's resistance.

⑧Pain can cause sleep disorders in patients, as well as negative emotions such as anxiety, fear, helplessness, and depression, which can have adverse effects on patients' psychology and behavior, causing family members to panic and feel helpless.

⑨If the pain is not well controlled, it can develop into chronic pain. Long-term pain can also cause psychological and mental changes in patients.

Can current medical technology achieve painless surgery?

The current level of medical care can basically achieve postoperative painlessness, and even comfortable medical care throughout the perioperative period, that is, more emphasis is placed on humanistic care for patients and improving the medical process and experience. Secondly, the existing analgesic technology and drugs can achieve postoperative painlessness without significantly increasing the risk to patients. Anesthesiologists will regularly evaluate and adjust the analgesic plan according to the individual needs of patients.

What are the commonly used postoperative analgesia techniques?

The currently advocated pain treatment model is multimodal analgesia. The use of multimodal analgesia and combined medication can reduce the dosage of narcotic analgesics and drug side effects. For acute postoperative pain, the most commonly used methods in clinical practice are intravenous patient-controlled analgesia and epidural patient-controlled analgesia. In our hospital, intravenous or subcutaneous injection of patient-controlled analgesia is used more frequently.

What are the commonly used PCA drugs?

The main analgesics for PCA are still opioids or their derivatives, including fentanyl, sufentanil, nalbuphine, dezocine, etc. Some anesthesiologists also add nonsteroidal anti-inflammatory drugs, NSAIDS drugs, serotonin receptor blockers, etc. to the analgesia pump.

Advantages of postoperative analgesia:

①Inhibit stress response

② Reduce the occurrence of adverse cardiac events

③Reduce the occurrence of pulmonary complications

④Promote gastrointestinal function recovery

⑤Improve postoperative hypercoagulable state

⑥Regulate human immune function

⑦ Reduce the damage of cognitive function after surgery

⑧ Promote early recovery of patients and shorten hospital stay

⑨Reduce the occurrence of chronic pain

⑩Other benefits of postoperative analgesia: can reduce the incidence of postoperative chills

What is Patient Controlled Analgesia (PCA)?

PCA has the advantages of rapid onset of effect, no analgesic blind spot, relatively stable blood drug concentration, timely control of breakthrough pain through shock doses, individualized medication, and high patient satisfaction. It is currently the most commonly used and most ideal method for postoperative analgesia and is suitable for moderate to severe pain after surgery.

What are the commonly used PCA devices?

Mechanical devices have a background dose infusion, and the rate cannot be adjusted, but they can be administered on demand.

The electronics can set the infusion rate as needed and can even deliver a background-free dose, also enabling medication to be given on demand.

There are two types of devices used for PCA: mechanical and electronic. How long should postoperative analgesia last?

When the pain assessment score is greater than or equal to four points or reaches moderate or severe pain, analgesia is required. This is because most of the postoperative pain of patients is concentrated within 48 hours after surgery, so the use time of PCA is 48 hours. Anesthesiologists can also make personalized adjustments according to the needs of patients and extend or shorten the use time.

What are the commonly used methods for pain intensity scoring?

① Visual Analogue Scale (VAS): There is no marking on the patient side, and a 1~100mm ruler on the physician side, with one end marked "no pain" and the other end marked "worst pain". The patient marks the corresponding position according to the intensity of the pain, and the physician determines the score.

② The Numerical Rating Scale (NRS) uses a scale of 0 to 10 to indicate different degrees of pain intensity, which is identified by the patient. "0" means no pain, "no 0" means the most severe pain, below 4 means mild pain (pain does not affect sleep), 4 to 7 means moderate pain, and above 7 means severe pain (pain causes insomnia or wakes the patient up from sleep).

What are the common side effects of using a PCA device? How can you deal with them?

Due to individual differences among patients, each patient's response to pain treatment will be different, and the side effects that occur will also be different.

The most common side effects are nausea and vomiting. If the patient has severe nausea and vomiting, the ward nurse should be informed in time, and the attending physician or anesthesiologist should be contacted for treatment. If necessary, the PCA device can be discontinued according to the doctor's advice.

The most serious side effect is respiratory depression. The patient first shows excessive sedation, long-term sleepiness, pinpoint pupils, decreased respiratory rate, decreased blood oxygen saturation, and respiratory amnesia in severe cases. When the above situation occurs, the PCA device should be discontinued immediately, and the attending physician should be contacted in time. At the same time, the patient should be awakened and given oxygen in time. If necessary, artificial ventilation and antagonist drugs can be used.

Other possible side effects include: skin itching, dizziness, and euphoria, which generally do not require special treatment.

If any abnormality occurs during the use of the PCA device, please contact the ward nurse or anesthesiologist in time for processing.

refer to:

Expert consensus on pain management after surgery in adults (2021)

Chinese expert consensus on the application of pain assessment scales (2020 version)

About the Author:

Yuan Fangfang, head nurse, anesthesia nurse in the operating room of Baoding Second Central Hospital.