References
Managing acute pain after abdominal surgery: examples from practice
Abstract
Following abdominal surgery, ischaemia and neuropeptide release cause pain at the trauma site, and there is a high incidence of moderate-to-severe pain. Inadequate pain management leads to complications, delayed recovery and prolonged hospitalisation, and thus, effective management is essential. This article describes an implementation of acute pain management after abdominal surgery. A multidimensional assessment tool collected data on demographics, medical history and surgical situation, as well as interventions used, their administration route and their side effects. Pain level was recorded on a scale of 0–10, both at rest and during physical activity, by postoperative day; patient participation and satisfaction were also recorded. Nine patients met the inclusion criteria for the study. Pharmacological analgesic interventions included opioids (morphine, fentanyl and tramadol) and paracetamol. Administration was either intravenous, epidural or via patient-controlled analgesia. These were combined with non-pharmacological interventions, specifically cold gel packs, massage therapy and music therapy. All patients achieved the adequate management goals of pain at rest below 3/10 and during activity below 4/10, and all participated in pain decision-making, were satisfied with pain treatment, and reported the usefulness of preoperative information. Pain management following abdominal surgery is vital, and the use of a combination of pharmacological and non-pharmacological techniques was effective.
Postoperative pain is a continuing problem (Chanif et al, 2012). More than 80% of patients complain of pain during the immediate postoperative period, with 75% rating it as moderate, severe or extreme. Additionally, evidence indicates that less than half of patients experience adequate pain management (Chou et al, 2016).
Acute postoperative pain begins with surgical trauma, tapers off gradually and ends with tissue recovery (Topcu and Findik, 2012). Abdominal surgery is recognised as a particularly painful procedure. Pain is caused by ischaemia and the release of neuropeptides at the trauma site and throughout the nervous system, due to the site’s proximity to the diaphragm and cross-innervations in the abdominal area. Pain is an unavoidable side effect of all major abdominal operations (Rejeh et al, 2013; Watkins et al, 2014; Nurhayati et al, 2019).
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