What to do if you can’t bear the pain after surgery? Don’t just bear it, experts will teach you how to do it

Someone once said: "Pain is a gift from God to mankind. Because of pain, humans can avoid harmful stimuli in time, thus avoiding greater harm." However, is this really the case? In medicine, there is nothing to be "praised" about pain. On the contrary, surgical pain, especially postoperative pain, will bring a strong stress response to the human body, which will have adverse effects on various organs and systems.

1. Effects of postoperative pain on the body

Postoperative pain is a reaction of the body after surgical trauma (tissue damage), including a series of physiological, psychological and behavioral reactions. Although postoperative pain can warn patients to immobilize the affected area, the adverse effects it brings are more worthy of attention. Effective analgesia management after surgery can not only relieve the patient's pain, but also help the patient's recovery. So, what effects does pain have on the body?

1. Impact of pain on the circulatory system:

The heart rate increases, blood vessels constrict, the cardiac load increases, myocardial oxygen consumption increases, and the risk of myocardial ischemia and myocardial infarction in patients with coronary heart disease increases.

2. Effect of pain on the respiratory system: surgical trauma activates nociceptors, which in turn triggers multiple harmful spinal reflex arcs, inhibiting the spinal reflex of phrenic nerve excitation, resulting in reduced lung function after surgery. This effect is particularly evident after upper abdominal and thoracic surgery. In addition, pain causes shallow and rapid breathing, stiffness of respiratory auxiliary muscles, reduced ventilation, inability to cough forcefully, inability to clear respiratory secretions, leading to atelectasis and other lung complications.

3. The impact of pain on gastrointestinal motility: leading to reduced gastrointestinal motility and delayed recovery of gastrointestinal function.

4. Impact of pain on urinary system function: The motility of urethra and bladder muscles is weakened, causing urinary retention.

5. Effects of pain on bones, muscles and peripheral blood vessels:

It leads to increased muscle tension, causing muscle spasms, restricting body activities, and may trigger deep vein thrombosis or even pulmonary embolism.

6. Effects of pain on the neuroendocrine and immune systems: Neuroendocrine stress response is enhanced, triggering postoperative hypercoagulable state and immune inflammatory response; sympathetic nerve excitement leads to increased secretion of catecholamines and catabolic hormones and decreased secretion of anabolic hormones; and inhibits humoral and cellular immunity.

7. Impact on psychological and emotional aspects: causing negative emotions such as anxiety, fear, and sensitivity.

2. Pain intensity scoring method

The Visual Analog Scale (VAS) is the most commonly used unidimensional measurement and assessment tool for pain intensity. VAS is mainly composed of a 100 mm straight line, one end of which represents "completely painless" and the other end represents "the most severe pain imaginable" or "extreme pain". Patients will be asked to mark the corresponding position on this line (using a "•" or a "✕", etc.) to represent the intensity of the pain they are experiencing at the time.
After subsequent revisions, VAS formed a face chart, with smiling or crying faces next to the VAS scale that are easy for children to understand. It is mainly suitable for assessing pain of various natures in children over 7 years old with normal consciousness.

3. Pain ladder treatment

The first step is to use non-opioid analgesics for mild pain: acetaminophen, aspirin, and ibuprofen.
The second step is moderate pain with weak opioids plus or minus nonsteroidal anti-inflammatory drugs plus or minus auxiliary analgesics: codeine, bucinnazine hydrochloride, tramadol.
The third level of severe pain is opioids plus or minus nonsteroidal anti-inflammatory drugs plus or minus auxiliary analgesics: morphine, pethidine.

4. Postoperative analgesia methods

Postoperative analgesia methods include multimodal analgesia, local anesthetic analgesia, intravenous analgesia, patient-controlled analgesia (PCA), oral analgesia, intramuscular analgesia, etc.

Among them, PCA is currently the most commonly used and most ideal method for postoperative analgesia. It 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 suitable for the management of moderate to severe postoperative pain.

Common parameters of electronic venous pumps

Loading dose: refers to the first dose of medication at the beginning of PCA.
Continuous dose or background dose: The drug in the analgesia pump will be continuously infused at a certain rate to give the patient a small dose of basic analgesia. The purpose is to maintain a stable blood drug concentration to ensure a stable and continuous analgesic effect after surgery.
Bolus dose: refers to the use of fast-acting drugs to quickly stop the breakthrough pain when the patient's pain fails to be relieved or the pain recurs after PCA.
Lockout time: refers to the time interval between two effective drug administrations. Its meaning is that if the patient's two compressions are within the lockout time, the second compression will be considered invalid.

summary

With the continuous development of medicine, the optimization of anesthesia schemes, and the advancement of the concept of multimodal analgesia, how to relieve or reduce postoperative pain has attracted more and more attention from patients. The application of analgesia pumps in clinical practice can effectively reduce postoperative pain. Targeted analgesia schemes can reduce anesthesia complications, accelerate patient recovery, further shorten the length of hospital stay, and promote the improvement of patients' life and social functions, so that they can return to society and family.
The Department of Anesthesiology of Peking University Third Hospital has always been serving patients. It not only provides painless solutions for perioperative patients, but also provides painless diagnosis and treatment technology services for patients receiving outpatient examinations, so that patients can accept various examinations with confidence. We hope to contribute to the high-quality development of the hospital and protect the life and health of patients through multi-departmental collaboration.