Understanding Post-operative Pain Types and Causes.

• Surgical pain management includes both anesthesia and analgesia.
• Surgery is traumatic on the body.
• Surgical pain is different from other types of pain, it is multifactorial, involving manipulating, cutting/tearing, then repairing skin, muscles, bones, tendons, ligaments, nerves and organs.
• Surgical intervention can lead to neuropathic pain and nociceptive pain.
• Nociceptive pain can be somatic or visceral.
• Surgical pain can also be caused by positioning during surgery, retractors, drains and tubes, incisions, CO2 gas from laparoscopy, and post-operative changes.
• Post-operative changes that can cause surgical pain include mobilizing, dressing changes, and lying in bed.
• The nurse's role in surgical pain management includes pre-operative assessment related to pain concerns, client education, assessing with appropriate tools, and ensuring pain relief measures are being employed.
• The nurse's continuous role is to document, communicate with other healthcare team members, and to monitor pain relief strategies with their effectiveness.
• Nurse's pre-operative role includes interviewing to determine clients fears and concerns about medication and alcohol use, prior surgical experiences, pain relief and strategies, as well as chronic pain.
• Pre-operatively, the nurse's role includes client education/teaching, about analgesia, PCA/epidural use, regular medications, and non-pharmaceutical pain strategies
• Complications of poor pain control can include altered respiratory and cardiovascular function, increased risk of pneumonia, atelectasis and chronic paid, altered GI/GU function, stress response, delayed wound healing, and decreased mobility.
• Unment patient needs can impact comfort, safety, activity, rest, sleep, nutrition and oxygenation.

Analgesia vs Anesthesia

• Analgesia is pain relief without loss of consciousness or loss of feeling or movement.
• Anesthesia is a state achieved when there is a loss of touch, pain, and temperature sensations with or without loss of consciousness.
• Common analgesics include Fentanyl, Hydromorphone, Morphine, and Oxycodone.
• Opioids have many side effects that can be life threatening and that affect multiple body systems, including constipation, nausea, vomiting, urinary retention, respiratory depression, bradycardia, hypotension and confusion.
• Listed from the 'weakest' to strongest:, Oxycodone, Morphine, Hydromorphone, Fentanyl.
• A route of analgesia administration can be oral, subcutaneous, intramuscular, or intravenous.
• The preferred route of adminstration is oral as it is best when the GI is functioning, with the slowest onset, and is better for opioid naive clients, but they may require higher doses.
• Subcutaneous administration is used as a 'bridge' between IV and oral administration, with an onset faster than oral, and commonly used for the provision of long term palliative care.
• Intramuscular is not reccommended for pain control, as it is medication-limited, may cause pain on injection and unreliable absorption, and needs to be repeated frequently.
• Intravenous administration has the quickest onset and is effective for steady pain control, includes both single doses and continuous infusion in a PCA, but is the riskiest overdose and requires the most supervision.
• Patient controlled analgesia (PCA) uses an infusion system, which is "controlled" by the client.
• The patient is able to press a button to recieve medication, which is primarily via the IV or epidural route, at is frequently given with a continuous basal rate.
• When using a PCA, the nurse must set the dose per hour and lockout interval.
• Commonly used medications in a PCA include Morphine, Fentanyl and Hyrdromorphone.
• Advantages of the PCA are the patient having a degree of control, allowing self-medication while staying safe, maintain stable medication levels and using less medication on average.
• Disadvantages of the PCA are the expense, the need for client understanding of how it operates, the need for monitoring, and education on pump use.
• PCA monitoring/documentation should include:
  • Vital signs and O2 stats
  • Pain level (0-10)
  • Level of sedation
  • Lockout period, bolus dose, and dosage

Types of Anesthesia

• Anesthesia is the loss of senation in all or part of the body wth or without loss of conscioness.
• Anesthesia may include analgesia, amnesia, paralysis, anxiolysis and unconsciouness.
• Types of anesthesia include local, regional, procedural sedation, and general.
• General anesthesia alters physiological state, loss of conciousness, skeletal muscle relaxation, amnesia, analgesia.
• Local Anesthesia is the loss of senation without loss of conciousness, and it able to be given topically, intracutanous or subcutaneous.
• Regional anesthesia is a reversible loss of sensation, where nerve fibres are blocked, including peripheral nerve bolck, spinal block and edidural block.
• Types of Anesthesia are selected based on the type of procedure, its length, and the patient's physical and mental health, age, allergies, and family history.

General Anesthesia

• This induces a reversible state of unconscioness with loss of sensation of the entire body,
• Achieved using general anesthetics +/- analgesics, anxiolytics, paralytics
• General anesthertics are medications used for the induction and/or maintenance of general anesthesia.
• Types include; Inhalation (Sevoflurane, Desflurane, Isoflurane, Nitrous Oxide) and Intravenous (Propofol, Ketamine and Etomidate.
• Common side effects are confusion, cognitive decline, sore throat, headache, chills, shivering, muscle plain, nausea and vomiting while more serious issues may be: hypotension, respiratory depression and allergic reactions.

Methods of administration

• Local anesthetics includes topical and local infiltration.
• Regional anesthetics includes peripheral nerve block, spinal block, or epidural block

Using Local and Regional

• The sodium channel is blocked.
• Nerve conduction prevents motor functions.
• Block sensory, motor and autonomic sensations.
• Regional (peripheral) nerve block includes intraoperative and post operative anesthesia and pain management

Spinal Anesthesia (Intrathecal) Block

• Injection of anesthesia (with analgesia) in to the fluid below Lumbar 2.
• Autonomic, sensory and motor activity may be used for surgeries (rarely).
• Spinal anesthetic medications may include Bupivacaine or Lidocaine.
• Analgesia medications are Fentanyl, morphince sulfate.

Spinal block with an Anesthesia

• Medication works fast with peak (faster and great)
• No catheter and drug is absorbed fast in a systemic area
• Limited surgeries and possible potential auto block, BP drops, slow heart rate cardiac arrest and vomiting as its depression of breathing mechanism.
• Postoperative monitoring with spinal anesthetic with hypotension or a spinal anaesthesia.
• Check vital signs for mobility, motor/ sensory block, and urinary output and determine the need for distension or heachache.

Epidural Anesthesia

• Injection of anesthesia (and analgesia) into the space, as either a single dose or infusion, lumbar, for childbirth and surgery on chest/ abdomen.
• Titrate a low conctration of sensory sensations.
• Bupivacaine and Fentanyl, or morphine sulfrate, or hydromorphone medications
• The main risk is for catheter displacement and heachache.
• Check vital signs with potential of Complications or Cardiac toxicity or high dose, and to check dressing site to prevent complications.
• Continuous Epidural Analgesia are either contious basal rate, intermittent is by Bolus.
• OIIQ monitoring for drugs, assess the Pression, Vital signs, pain score

Spinal v epidural

• Epidual and Spine the block has a limited duraation or direct cerebro fluid, and creates some motor blocks
• Spinal block faster, epidural slowers but they are similar and able to make the catheter
• In spinal the side effects are likely for a headache

Post ANesthesia/ Analgesia Clients

• Ensure the floor, and be able to head to toe, assessment (surgical area/ client
• Check tubes and order the chart from all tests
• Review the orders before assess PREES , pain, resport, emotional state

Opioids

• Remind clients monitor the IV so they are following the IV or by epiodural assessment
• Look the dose or the action on the oipiod

Guideline for IO and assess

• 99. 120 minutes
• Duration of action for LOS and RR, oxygen
• Monitor at action when opioid

Respiratory Depression and Over sedation

• Scale greater than or equal 3. O2 will be at 90 as indicated
• Naloxone if there has been too much IV or O2 usage Oipiod GI review and assessments
• Review for stool softeners if needed, and avoid medication and monitor if medication need to be given avoid gving on empty stomach
• Monitor the patient in uniary
• Review all meds with the patient after procedure
• Use lease amount to make the client at less pain, and provide to client after dressing change

Final Points

• Do throrough pain assessment and take vitals
• Check during and action and check the client for their wellness

Explore types and causes of post-operative pain, like incisional, referred, and neuropathic pain. Learn factors influencing the pain such as patient positioning and surgical techniques. Understand the differences between surgical and other pain types.