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Surgery -Analgesia
Effectively managing a patient's pain during the perioperative period is a fundamental obligation of a surgical student. The advantages of managing acute pain encompass: • Wound healing. • Mobility. • Patient contentment. • Premature hospital discharge. • Decrease in the likelihood of thromboembolic occurrences. In instances of acute pain resulting from trauma, surgery, delivery, or a medical condition, it is crucial to ascertain the location, temporal characteristics, and intensity of the pain. Various approaches are available for evaluating the patient's pain
Techniques for Evaluating Acute Pain
Visual analogue scale (VAS)
-Scored between ‘no pain’ and ‘pain as bad as it can be’
Verbal response score (VRS)
Pain scored as a number, e.g. 4 out of 10, or verbally, e.g.
mild, severe, excruciating
Autonomic response
Sweating, tachycardia, hypertension (HTN)
Dynamic pain scores
Pain on movement; ability to take a deep breath; ability
to cough
The objective of postoperative analgesia is to reduce the dosage of analgesic drugs, hence avoiding side effects, while ensuring sufficient and efficient pain relief. The World Health Organization analgesic ladder This was initially devised for the management of persistent pain associated with cancer. The ladder is being employed to address multiple forms of pain. The technique involves the immediate prescription of analgesics upon the onset of pain and the adjustment of the regimen until the patient achieves pain relief, utilizing the ladder system
Postoperatively, patients will necessitate potent and effective analgesia. The oral route is favored whenever feasible. In the acute postoperative phase or in cases of vomiting, intravenous administration may be necessary.
The intramuscular (IM) method is unpleasant and has inconsistent absorption; it should be avoided when feasible. The analgesic regimen can be titrated down utilizing the World Health Organization (WHO) ladder as the patient convalesces in the days subsequent to the procedure. To guarantee that patients receive consistent and extended analgesia, these should be supplied routinely rather than on an as-needed basis. Adjuvant medicines are agents that augment the efficacy of analgesics, such as anticonvulsants like gabapentin utilized for neuropathic pain.
WHO Pain Relief Ladder
Mild pain
Non-opioid (e.g. aspirin, paracetamol or NSAID) +/− adjuvant
Mild to moderate pain
Weak opioid (e.g. codeine)
+/− non-opioid
+/− adjuvant
Moderate to severe pain
Strong opioid
(e.g. morphine)
+/− non-opioid
+/− adjuvant
Effectively managing a patient's pain during the perioperative period is a fundamental obligation of a surgical student. The advantages of managing acute pain encompass: • Wound healing. • Mobility. • Patient contentment. • Premature hospital discharge. • Decrease in the likelihood of thromboembolic occurrences. In instances of acute pain resulting from trauma, surgery, delivery, or a medical condition, it is crucial to ascertain the location, temporal characteristics, and intensity of the pain. Various approaches are available for evaluating the patient's pain
Techniques for Evaluating Acute Pain
Visual analogue scale (VAS)
-Scored between ‘no pain’ and ‘pain as bad as it can be’
Verbal response score (VRS)
Pain scored as a number, e.g. 4 out of 10, or verbally, e.g.
mild, severe, excruciating
Autonomic response
Sweating, tachycardia, hypertension (HTN)
Dynamic pain scores
Pain on movement; ability to take a deep breath; ability
to cough
The objective of postoperative analgesia is to reduce the dosage of analgesic drugs, hence avoiding side effects, while ensuring sufficient and efficient pain relief. The World Health Organization analgesic ladder This was initially devised for the management of persistent pain associated with cancer. The ladder is being employed to address multiple forms of pain. The technique involves the immediate prescription of analgesics upon the onset of pain and the adjustment of the regimen until the patient achieves pain relief, utilizing the ladder system
Postoperatively, patients will necessitate potent and effective analgesia. The oral route is favored whenever feasible. In the acute postoperative phase or in cases of vomiting, intravenous administration may be necessary.
The intramuscular (IM) method is unpleasant and has inconsistent absorption; it should be avoided when feasible. The analgesic regimen can be titrated down utilizing the World Health Organization (WHO) ladder as the patient convalesces in the days subsequent to the procedure. To guarantee that patients receive consistent and extended analgesia, these should be supplied routinely rather than on an as-needed basis. Adjuvant medicines are agents that augment the efficacy of analgesics, such as anticonvulsants like gabapentin utilized for neuropathic pain.
WHO Pain Relief Ladder
Mild pain
Non-opioid (e.g. aspirin, paracetamol or NSAID) +/− adjuvant
Mild to moderate pain
Weak opioid (e.g. codeine)
+/− non-opioid
+/− adjuvant
Moderate to severe pain
Strong opioid
(e.g. morphine)
+/− non-opioid
+/− adjuvant
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