Post-operative pain

Pain after surgery is the pain that occurs after surgery. It is a kind of acute pain. It is mainly caused by acute trauma (incision) and/or internal organ damage and stimulation and drainage caused by the surgery itself. The general peak period is surgery. After 24 to 48 hours.

Cause

The pain after surgery is closely related to the size of the surgical trauma, the intensity of the invasion of internal organs and the length of the operation time, as well as the mental state of the patient.

Clinical manifestations

1. symptom

The patient complained of pain, manifested as pain at the incision or deep pain.

(1) Pain at incision wound: This type of pain is caused by skin sensation, and the pain is relatively superficial. When the patient is resting, the pain is dull; when the patient takes a deep breath, coughs or turns over, the incision is traction, which can cause intense pain, mostly sharp pain. If there is a subcutaneous hematoma, incision inflammation, and ischemia, the pain will aggravate.

(2) Deep pain: This type of pain is mostly caused by the pulling and tearing of the internal organs in the operation, and the pain is deep. Poor drainage after thoracotomy can cause pleural effusion or hemorrhage, and gas storage in the stomach and intestines after laparotomy can aggravate the pain.

2. Mental state

Patients often produce various emotional abnormalities due to painful stimulation, such as depression, anxiety, irritability, and abnormal sleep.

3. Pain assessment

Clinically, a variety of scoring methods are used to evaluate the degree of pain, such as the oral depiction scoring method, digital scoring method, visual analog scoring method, McGill pain questionnaire, etc. According to the World Health Organization standards and the clinical manifestations of patients after surgery, some people divide the pain degree into the following four levels:

Grade 0 (no pain): The incision is painless when the patient coughs.

Grade 1 (mild): mild tolerable pain, can live a normal life, sleep is not disturbed; feel a slight pain in the incision when coughing, but can still cough effectively.

Grade 2 (medium): moderate persistent pain, disturbed sleep, analgesics are needed; the patient is afraid of coughing, afraid of minor vibrations, and the incision is moderately painful.

Grade 3 (heavy): Intense and continuous severe pain, sleep is severely disturbed, analgesics are needed to relieve the pain.

Pain after surgery is mostly the subjective feeling of the patient, and related examinations are greatly affected by the patient's

psychology and tolerance.

1. Laboratory examination

It can be seen that the secretion of various hormones such as catecholamines, angiotensin II, aldosterone and adrenal cortex hormones have increased.

2. Pulmonary function tests

The measurement of maximum ventilation and forced expiration in the first second has a certain effect on the evaluation of pain after chest and upper abdominal surgery.

Diagnosis

Diagnose according to the nature and location of the pain, the time when the pain appears, and the patient's emotional performance. Need to rule out the pain caused by other organic diseases.

Treatment

The treatment methods for postoperative pain are mainly the general application of narcotic analgesics and local nerve block. General anesthetic analgesics are mainly opioid analgesics, and they are administered in various ways, such as oral, intramuscular injection, and intravenous injection. With the application of patient-controlled analgesia (PCA) technology, both general anesthetic analgesics and local nerve block can be administered by PCA technology, allowing patients to inject a predetermined dose of drugs into the body through a micro pump when they feel pain. Following the principle of "analgesia on demand", a satisfactory analgesic effect can be obtained with the smallest dose.

Reference:

Xu Jianguo. Progress in the treatment of postoperative pain in adults. "CNKI; WanFang", 2011

Gao Wanlu, Wang Xiaohai. Preoperative selection of patient pain scoring method and analysis of the effect of postoperative pain assessment. "CNKI", 2013

Bi Na, Yao Meifang, Huang Jinfang, etc. Analysis of causes of pain and discomfort after valve replacement and nursing countermeasures. "CNKI", 2000

Li Yinglan. Investigation and analysis of the relationship between preoperative anxiety and postoperative pain in patients undergoing cholecystectomy. "CNKI", 1999

Bina. Progress in postoperative pain and analgesia. "International Journal of Nursing", 1999

术后疼痛 術後疼痛

手术后疼痛即手术后出现的疼痛，属急性疼痛的一种，主要是手术本身造成的急性创伤（切口）和（或）内脏器官损伤及刺激和引流物的刺激引起的，一般高峰期是术后24～48小时。