Acute Post Operative Pain Management Emma Lamont - 18 Weeks

NHS National Waiting Times Centre
Acute Post Operative Pain Management
Emma Lamont

NHS National Waiting Times Centre
The Patient in Pain
• “By any reasonable code, freedom from pain should be a basic
human right limited only by our knowledge of achieving it”
• Liebeskind & Melzack
Pain. 1987.
• “Pain is whatever the person experiencing it says it is, existing
whenever the person says it does”
• McCaffery 1968
• “an unpleasant sensory and emotional experience associated
with actual or potential tissue damage or it is described in terms
of such damage”
• The International association
for the study of pain

NHS National Waiting Times Centre
Pain
“Pain is a multifactorial experience, not just a
sensation. Emotion,perception and past experience
all affect an individuals response to noxious stimuli.
Improved post operative pain control through
innovation and creativity may improve compliance,
ease of delivery, reduce symptoms and aggressive
treatment of pain using an integrative approach,
combining pharmacotherapy as well as
complementary technique, should serve us well in
dealing with this complex problem”
• Shang & Gan, Optimising Post operative pain
management in the ambulatory patient. 2003

NHS National Waiting Times Centre
Why manage Pain?
• Humanitarian
• “By any reasonable code, freedom from pain should be a basic
human right limited only by our knowledge of achieving it”
- Liebeskind & Melzack Pain. 1987.
• Cost Effectiveness
* Pain impedes mobilisation after surgery
and may lead to such things as:
–Post operative complications (leading to
delayed stay in hospital or ICU admission)
–Deep Vein Thrombosis
–Pressure sores
• Respiratory Function
• Cardiovascular system
• Gastrointestinal system
• Stress response to surgery
* Good pain relief ensures:
–Less post operative
complications
–Earlier discharge from Hospital
–Less demands on Clinical time

NHS National Waiting Times Centre
The Patient in Pain
• Pain, the 5 th Vital Sign
• Kathy Quan 2006
• Pain is always subjective.
• No direct test or observation can accurately
determine whether a patient is in pain.
• How do we assess pain?
• Look
• Listen
• Assess, review, document and re-assess

NHS National Waiting Times Centre
The Patient in Pain
• How do we assess & document pain?
• Behaviour
• Expressions, body language, physiology
• Verbal Scale
• None, Mild, Moderate, Severe
• Numerical
• 1, 2, 3, 4
• Visual Analogue
• Wong Baker, 10cm ruled line

NHS National Waiting Times Centre
Why We Assess Pain
• To improve patient care
• As a means of standardising each individual
patients pain.
• For legal reasons
• To support actions
• To improve surgical outcome
• Audit/research purposes
• QIS & NICE guidelines say we have to!

NHS National Waiting Times Centre
Why have a “Pain Service”?
Joint College Report on
“Pain After Surgery”, 1990.
• “Pain – a subjective experience that can be
perceived directly only by the sufferer.”
• “The treatment of pain after surgery in British
Hospitals has been inadequate and has not
advanced significantly for many years.”

NHS National Waiting Times Centre
The Patient in Pain
“Multimodal Analgesia”
• A combination of analgesia resulting with a
synergistic affect
• Well described in the available Medical Literature
• The goal of pain management is not necessarily
“zero” pain rather it is the maximally functional
patient, with the patient ultimately deciding if the
goal has or has not been reached.
• Kathy Quan 2007

NHS National Waiting Times Centre
The Patient in Pain
• Key points
• Multimodal Analgesia
• No one dose or analgesia suits all patients
• We are individuals and should be treated as such
• Assessment of the patient experiencing pain is the
cornerstone to optimal pain management.
• Pain assessment should be ongoing, individualised,
and documented.
• Pain relief should be a basic human right