According to Baylor University Medical Center, effective postoperative pain control is essential not only for the humane treatment of the patient, but also to decrease morbidity and mortality. Regional techniques are the most effective, followed by high dose opioids and non-steroidal anti-inflammatory drugs. The advantages of good pain control include early mobilization, decreased pulmonary and cardiac complications, faster recovery and decreased length of stay in the hospital.
Regional Anesthetics
Regional anesthesia, such as epidurals and spinal anesthetics, have been shown to improve surgical outcomes by decreasing blood loss and improving postoperative lung function, according to Baylor University Medical Center. When the patient's pain is manageable, they are able to cough up secretions that otherwise might lead to pulmonary pneumonia. Epidurals are placed at a level in the spinal cord that is above the level where surgery is to take place. Spinal anesthesia is injected into the fluid within the spinal cord. This usually only need be done once unless further analgesia is needed during the procedure. An epidural requires a small catheter be placed in the epidural space of the spinal cord. The epidural catheter can be left in postoperatively to provide continuous pain relief during the first one to two days post surgery. Epidurals have the potential to cause low blood pressure in postoperative patients.
Opioids
Opioids or narcotics can be administered in many different ways. These medications can be swallowed, injected, pushed through an intravenous line, applied in a transdermal patch or given subcutaneously. Intravenous infusion tends to deliver a more consistent level of drug to the system. Drugs such as morphine, dilauded, fentanyl and meperidine can be used. Narcotics act on the central nervous system, which means they affect an area in the brain. Because of the central action of narcotics, they also tend to cause drowsiness and respiratory depression. Patients who are receiving medications through an intravenous line need to be monitored closely in order to prevent respiratory arrest. The advantage of narcotics is that their sedative effect can be quickly reversed with naloxone.
NSAIDS
Nonsteroidal anti-inflammatory drugs, NSAIDS, reduce pain by acting on prostaglandins that produce pain and fever.Often NSAIDS are used after laparoscopic surgical procedures for pain control. NSAIDS can be given intravenously or orally. Side effects include renal impairment and bleeding ulcers. Proton-pump inhibitors such as pantoprazole, taken orally or given intravenously should be used concomitantly to protect the stomach lining from NSAIDS deleterious effects. NSAIDS do not have the sedative effect that narcotics do and can be used in conjunction with narcotics in order to provide effective pain control.
