Postoperative pain

The factors responsible for these differences includes duration of surgery, degree of operative trauma, type of incision, and magnitude of intraoperative retraction. Feelings such as helplessness, fear, and uncertainty contribute to anxiety and may heighten the patients perception of pain. The physiology of postoperative pain involves transmission of pain impulses via splanchnic (not vagal) afferent fibers to the central nervous system, where they initiate spinal, brain stem, and cortical reflexes. Spinal responses to skeletal muscle spasm, vasospasm, and gastrointestinal ileus. Brain stem responses to pain include alterations in ventilation, blood pressure, and endocrine function. Cortical responses include voluntary movements and psychologic changes, such as fear and apprehension. These emotional responses facilitate nociceptive spinal transmission, lower threshold for pain perception, and perpetuate the pain experience.
A. Physician-patient communication
Close attention, frequent reassurance, discussions with the patient every day.
B. Parental opioids
Side effects of Morphine include respiratory depression(rare because pain is powerful respiratory stimulant), nausea and vomitting, and clouded sensorium.
Meperidine is an opioid about one-eighth the potency of morphine. Hydromorphone in a dose of 1-2mg im every 2-3hours. Methadone in average dose 10mg im or orally every 4-6mg hours.
C. Nonopioid parental analgesic
Ketorolac(NSAID) 30mg has analgesic efficacy roughly equivalent to that of morphine 10mg. Complications (Nsaid) of ketorolac have not yet been reported with short-therm perioperative.
D. Oral analgesic
For more severe pain, oxycodon is an opioid with slightly less potency than morphine. Hydrocodone is a synthetic opioid with properties similar to those of codein.
E. Continous epidural analgesia
Epidural opioids produce intense, prolonged segmental analgesia with relatively less respiratory depression or sympathetic, motor, or other sensory disturbance. Epidural morphine is usually administered as a continuous infusion at a rate of 0,2-0,8 mg/h with or without the addition of 0,25% bupivacaine. Bladder catheterization is almost always required.