Pain after surgery

introduction

Every surgical procedure can then be accompanied by pain, the so-called "postoperative pain". Usually pain is a warning function of the body to protect itself from harm. Since pain is artificially generated in the course of an operation, it has no warning function in this case. Post-operative pain is very uncomfortable for the patient. In addition, it is now known that they have an adverse effect on the healing process. For these reasons, modern medicine strives to eliminate postoperative pain as much as possible.

aims postoperative pain therapy:
As far as possible freedom from pain gives the operated patient the opportunity physiotherapy and breathing therapy exercises to be carried out much more effectively than in pain. This helps the patient to sit up, stand up and walk sooner. Post-operative pain therapy also aims to provide a weakening of Immune system by preventing pain and thus strengthening the defenses against infections. That too Cardiovascular system and the Gastrointestinal tract are negatively affected by pain, making a successful postoperative Pain therapy can also have positive effects here.

Before the operation

Even before the operation, in Educational talk through the Anesthetist, becomes the cornerstone of a successful postoperative Pain therapy placed. The doctor explains to what extent pain is to be expected after the respective procedure and how it is usually treated. This enables the patient to adjust accordingly and thus Reduce fears.
With regard to pain management during and after surgery, doctors should know whether the patient is regular pain relievers takes or alcohol or others Drugs consumed. This may require the use of other medications and / or dosages. If severe pain is to be expected during an operation, a Blockage of regional ducts in addition to the respective anesthetic method.

Causes of pain

In most cases, the development of postoperative pain is closely related to the execution of skin incisions and the displacement of tissue. During a surgical procedure you can strong forces act on the operating area, the the Traumatize tissue.
In addition, postoperative pain is caused in many cases Repositioning maneuvers caused during the procedure. Especially that Moving bones and bone fragments can seriously affect the surrounding tissue and thus lead to postoperative pain.

It is also necessary in the course of some surgical procedures drain the resulting wound secretion through a drain. This is one thin tube which is provided with a small container at the end. The drainage is still going introduced during the operation and has to stay in the operating area until it hardly pumps any secretion. Many patients who have postoperative pain report significant pain Relief of the discomfort after removal of the wound drainage.

Postoperative pain can, however also outside the actual operating area occur. The reason for this can be a incorrect or simply uncomfortable positioning during the procedure be. In addition, postoperative pain can be in the area of ​​the Indwelling cannulas (PVC) through which the patient is supplied with fluid and / or medication arise. Also the artificial respiration during the operation, or rather that Insertion of the ventilation hose (Tube), can lead to postoperative complaints. Affected patients often suffer from Sore throat, difficulty swallowing and hoarseness.

diagnosis

To Determination of post-operative pain Various systems are available in everyday clinical practice. To the most famous scales which are used to record postoperative pain include the Visual analog scale (VAS) that Verbal rating scale (VRS) and the Faces rating scale.

Visual Analog Scale (VAS)

With the help of the visual analog scale, postoperative pain can be measured recorded quickly and easily become. To determine the patient-specific pain intensity, the Presence of a doctor not necessary. In this system, one serves approximately 10 cm long line, the divided in 1 cm steps is the pain detection. The endpoints of the line stand for “no post-operative pain” up to “the strongest imaginable pain”. Patients are usually asked to do so every day after the operation Define pain perception using this scale.

Numerical Rating Scale (NRS)

With this system, the postoperative pain can assessed using numbers become. The patient is asked to respond to the complaints felt by him Number between 1 and 10 assign. The number 1 stands for "no pain" and the number 10 symbolizes the "worst pain you can imagine". A modification of the numerical rating scale is the so-called "Verbal Rating Scale" in which the patient should assign his individual postoperative pain to the levels: no pain, slight pain, moderate pain, severe pain or maximum pain imaginable.

Faces rating scale

The so-called "face rating scale" takes place especially in paediatrics Application. She is hiring simple symbolic agent for recording postoperative pain. The actual scale has a smiling, pain-free face on the left side. The right side, on the other hand, depicts a crying, pain-devoured face. The assessment of postoperative pain can taken by the patient himself or through Viewing the patient's facial expressions be developed.

Pain scales are still used in everyday clinical practice today ideal method for the assessment of postoperative pain in particular and pain states in general. Especially with regard to the treatment of pain phenomena and the Patient-specific dosage of pain medication regular implementation appears to be essential.

Description of the pain

There are different types of Painwhose treatment is different. For this reason, the more precisely the pain is described, the better the postoperative pain therapy. The exact place are called and the so-called Pain quality, the type of pain to be described.

For example, pain can be classified as stabbing, boring, dull or burning be characterized. Also the Pain intensity is an important factor. In many clinics, this is queried daily by the nursing staff on a scale from 0-10. With 0 there is freedom from pain, pain level 10 stands for the strongest imaginable pain. Also relevant for postoperative pain therapy is whether the pain is always present or recurs regularly and whether and by which factors the pain can be intensified or alleviated. To get an idea of ​​the healing process, the doctor also needs it Course of pain important. It should be observed whether the pain improves or worsens, whether the character changes and also whether the location of the pain shifts.

therapy

Treatment of pain that is im Relation to surgery arise (postoperative pain), is called in medical terminology "postoperative pain therapy". Postoperative pain is usually caused by the Give pain reliever medication treated. In this context there is a strict step-by-step plan which determines both the type and the dosage of the possible drugs. Although intravenous (about the vein) administered medication in most cases much faster and more effectively have an effect, oral administration of pain relievers (taking tablets or drops) should be preferred.

In patients who only slight postoperative pain have, the attending physician usually starts with the administration of so-called Non-opioid analgesics. These are comparatively weak painkillers such as Paracetamol, Ibuprofen or Novalgin. These drugs work through one Inhibition of the so-called cyclooxygenases. These are enzymes that are involved in the release of pain mediators, among other things. Active ingredients from the group of non-opioid analgesics can be used in Combination with opioids be applied. Opioids are strong painkillers that contain morphine-like substances and are many times more effective than drugs from the group of non-opioid analgesics.

To especially major operations however, the postoperative pain is often so severe that oral pain medication is required no more adequate relief brings. In these cases, the systemic administration of opioids is an important part of postoperative pain therapy. Opioid analgesics are effective directly on the central nervous system free by targeting the Block switching points of the nerve cells and in this way suppress the transmission of pain information. However, due to their mechanism of action, these drugs can also be administered strong side effects to lead. The most common side effects of opioids in the treatment of post-operative pain are Affecting breathing (Respiratory depression), the Release of the nausea, Constipation and Urinary retention. Mostly the patient suffering from postoperative pain becomes one catheter close to the spinal cord (so-called "peridural catheter"). You can use this access local anestheticsused to relieve post-operative pain, in the immediate vicinity of the Backmarks to be brought.

With most methods of postoperative pain therapy, the exact, patient-specific dosage is an enormous problem. Outsiders (relatives, doctors or nurses) can in most cases do not estimate how pronounced and intense the actual postoperative pain felt by the respective patient. The common pain scales can also be used just a clue give. It also provides the necessary Consultation between doctor and nursing staff an unnecessary one before the application of painkillers Time Delay in pain therapy. For this reason, the so-called "Patient-controlled analgesia (PCA for short) “has become the most effective method in the treatment of postoperative pain. The term “patient-controlled analgesia” is understood to mean a principle in which the individual patient is able to Dosage and application intervals the pain reliever chosen by the doctor to determine independently. This method can reduce the time between the need for medication and the actual use of medication reduced from about an hour to just a few minutes become. Postoperative pain becomes patient-controlled analgesia intercepted as they arise and thus can Well-being of the patient significantly improved. In addition, in this way the patient can Feeling of independence and independence mediated. In most cases, patient-controlled analgesia is done via a catheter near the spinal cord. The patient suffering from post-operative pain can get the dose of pain reliever they need Regulate yourself at the push of a button. In this way, a targeted dose adjustment to different intensities of the postoperative pain can be achieved. In this way, the patient is able to administer the drug different situations adapt.

For example, there is a Mobilization, repositioning or physiotherapy therapy which usually increases postoperative pain before the onset of pain a higher dose can be administered. In addition, the catheter is injected periodically Dose bolus (i.e. a basic amount of painkillers). This method also eliminates the risk of an overdose of the pain reliever, because the pain pump attached to the spinal cord catheter is programmed in such a way that a Maximum dose not exceeded can be. If the contraindications of patient-controlled analgesia are strictly observed, this procedure offers a number of advantages compared to the usual basic therapy for postoperative pain. Especially the Satisfaction and well-being of the individual patient can be increased significantly through the long, pain-free intervals. Ultimately, this also has an effect on the patient's psyche. In addition, the patient can Fears of severe postoperative pain relieved become.

Basic drug therapy

The WHO recommends the procedure for pain therapy based on a step-by-step scheme. The basis of every postoperative pain therapy are drugs from the group of nonsteroidal anti-inflammatory drugs, including known drugs such as ibuprofen or paracetamol.
They are usually given as a tablet, juice or suppository. In order to achieve lasting pain relief, it is necessary that the drug is always present in sufficient doses in the blood. Therefore, there are fixed dosages and times at which it should be taken.
Decongestant drugs such as bromelain which e.g. Can be purchased under the name Wobenzym®, is supposed to support healing and postoperative pain.

For patients with mild to moderate pain, treatment with this type of pain reliever alone is often sufficient. As part of the basic drug therapy, the regular recording of the pain intensity is of great importance in order to be able to adjust the pain therapy if necessary. If more severe pain occurs occasionally, for example during physiotherapy, the postoperative pain therapy can be supplemented with an additional stronger medication, which is taken if necessary. Drugs from the group of weakly effective opiates, which represent the second stage of the WHO pain scheme and are given in combination with the pain medication of the first stage, are suitable for this. This includes, for example, the drug Tramadol.

If a surgical procedure is very painful, a strong opiate such as the drug Dipidolor is administered in addition to the nonsteroidal anti-inflammatory drugs (stage 1).
Opiates work where the sensation of pain occurs: in the central nervous system. Typical side effects are nausea, constipation, and fatigue.
They can lead to restricted breathing and are generally capable of creating addiction. For this reason, opiates are feared by many patients, but this is unfounded as long as these drugs are taken as prescribed by the doctor.

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Regional anesthesia

pain is from the point at which the body is intervened, initially through nerves to the brain forwarded. It only arises in the brain Sensation of pain. If the pain is not passed on from the nerves to the brain, then the person does not feel any pain. This is what you do in the Regional anesthesia to use. As the name suggests, it does not numb the whole body, but only one region.

For example, if an operation on the arm is imminent, a Brachial plexus anesthesia be performed. This is a Nerve plexus in which all the nerves supplying the arm are located. This plexus of nerves can now be numbed. After the braid is in Ultrasonic was seen becomes a catheter pushed in and one local anesthetic and a Opiate Injected so that they wash around the nerve and numb it.

During interventions on Rib cage, belly and Legs can also be a Regional anesthesia but here it takes place in the spinal canal. Based on the height of the spinal cord, specific areas can be blocked. Creating a Regional anesthesia is usually done before the operation so that there is no pain during the procedure. After the operation, pain medication can still be injected through a catheter.

Regional anesthesia brings many advantages during and after an operation. So be total less anesthetic drugs needed. It also showed that in general Pain therapies with regional anesthesia fewer complications, such as Pneumonia, occur. Another great advantage of this method is that the opiate only act directly on the nerve. This avoids the typical side effects of this group of drugs such as constipation, nausea and tiredness. Often, patients who have been treated with regional anesthesia can get up more quickly after an operation and with the physiotherapy begin so the chances of one fast healing process are increased.

Patient-directed intravenous analgesia

The normal drug is enough Pain therapy for pain relief is not sufficient, a "patient-controlled intravenous analgesia", also known as PCA pump or pain pump. The basis of this therapy is a very effective one Opiate in low dosage, which over a venous access is given.

The medication is administered via this venous access via a remote-controlled pump. If the patient feels pain, they can administer this pain reliever to themselves using a remote control. To prevent overdose, the maximum dose before programmed. In addition, minimum distances between two gifts are specified. In this way, the patient is completely independent of the nursing staff and doctors and is able to administer pain medication if necessary.

Pain relief without medication

A drug pain treatment is for the post-operative pain therapy indispensable. In addition to medication, however, there are also some measures that can have a positive effect on postoperative pain.

Due to the significant influence of the psyche Anything can affect the sensation of pain increased relaxation the patient's pain reliever. So can Breathing exercises and Relaxation techniques, as well as music and deflectionhave a supportive effect. An incorrect body position can also put the operated wound under tension and thus lead to increased pain. Another can help here Body position to choose, possibly also by a different position of the bed. When asked by the nursing staff, most clinics also have additional pillows that can help with storage.

Risks

The greatest risk for patients who have to endure severe postoperative pain without effective pain therapy, the possible chronification of the complaints. Studies have shown that the risk of developing chronic pain increases after a surgical procedure has been carried out, with the pain intensity felt by the patient during the hospital stay. In addition, different risk groups for the development of chronic postoperative pain. Are considered particularly endangered anxious and suffering from severe psychological stress. That too Age plays a crucial role in the development of chronic post-operative pain. Generally are younger patients significantly more at risk than older people.

Summary

Under the term "Postoperative pain" is understood in medical terminology Pain phenomenathat occur after an operation and persist for a period of time.
Postoperative pain can vary both in its intensity and in the duration of its onset very different be. The exact form and location of the postoperative pain is included depending on the type and extent of the surgical procedure. In most cases postoperative pain goes away within a few days completely back. In addition, the symptoms perceived after an operation can be caused by the Administration of pain medication can be alleviated easily and quickly. Treatment for post-operative pain is straight within the first few days especially important after surgery. Otherwise there is the Risk of developing a so-called chronic pain syndromethat can turn into a pronounced pain disorder.