New Post-Operative Pain control Concept

Post-operative pain is one of the least things patients wish to endure and is listed one of their biggest concerns. Most patients still perceive pain under traditional post-operative analgesia. Post-operative  pain and improper pain control could results in the psychological and physiological impacts such as:

Anxiety	Respiratory distress	Cardiac arrhythmia, myocardial ischemia and heart failure
delayed gas passage	delayed recovery	Decreased immunity

• Anxiety, worries and fear.
• Difficulty in breathing: Particularly after the chest and abdominal surgery or trauma.
• Cardiac arrhythmia, myocardial ischemia and heart failure.
• Slow gastrointestinal activities and delayed gas passage.
• Causing the body to secret excess stress hormones and slowing down tissue recovery.
• Lowering immunity, increasing likelihood of infection and delaying time to discharge from the hospital. 

Post-operative analgesia is one important section of analgesia quality. There are many means of analgesia for selection, including the traditional intravascular or muscular administration, epidural administration, or implementation of nerve block. The ideal analgesic medicine should comply with the following: Powerful pain relief effect, clear mechanism of drug action, minor toxin and few side effects. In recent years the medical industry has developed a variety of new drugs and different administration paths to provide more choices for patients. Among which the analgesia pump via intravenous fluid is most commonly established for patients to independently press the button of the device so pre-set particular continuous or fixed amount of analgesia could be injected into the veins of the patients, known as the Intravenous Patient Controlled Analgesia (IVPCA). It is currently the mainstream in clinical handling of post-operative acute pain and applies to most surgeries, including the abdominal, anocelia and spine surgeries.

The installation of an analgesia pump inside the epidural catheter is known as the Epidural Patient Controlled Analgesia, commonly used in epidural anesthesia during labor or caesarean delivery surgery, abdominal, anocelia and limb surgery. Moreover, many surgeries could be incorporated with peripheral nerve blocks to assist with post-operative analgesia, the recovery process and the reduction of the amount of analgesics used.

Principles of using analgesics

As the patient's condition permits, oral administration is the principle. Oral analgesics is a convenient, inexpensive, independent and autonomous way to administer it. Injectable administration should only be considered when the patient cannot take orally or when acute pain needs to be rapidly relieved. Because repeated injections, whether via subcutaneous, intramuscular, or intravenous routes, may increase a patient's burden.

Analgesics should be prescribed based to three steps analgesic ladder guidelines:

• Step 1: Non-opioid plus optional adjuvant analgesics for mild pain.
• Step 2: Weak opioid plus non-opioid and adjuvant analgesics for mild to moderate pain.
• Step 3: Strong opioid plus non-opioid and adjuvant analgesics for moderate to severe pain.

Post-operative analgesics and treatment methods (drugs have various side effects, please note that they must be prescribed by a doctor)

There may be more than one source of pain, including dermal pain, visceral pain, muscle pain, ligament pain and neuropathic  pain, one kind of analgesic cannot relieve all types of pain. Therefore, multiple drug combinations or multiple pain relief methods are often required and the prescriptions must be made after a thorough evaluation  of the operation and clinical conditions of the patient. Therefore, in addition to the above-mentioned traditional single postoperative pain management method, our hospital also provides “Multimodal Analgesia” (MMA) to improve pain care quality for many complicated postoperative situations. You can ask your anesthesiologist for advices at preoperative anesthesia clinics.

Classifications, effects and side effects of analgesics

dequate post-operative analgesia not only reduces many complications but also makes patients recover sooner to discharge from the hospital.