Eliminating pain in 100% of cases after an operation is difficult, almost impossible. However, following some rules on the use of analgesics depending on the intervention and the patient can achieve better management of the discomfort after passing through the operating room. A study published in 'The Lancet' offers the essential keys to control this type of pain.
There are many kinds of pain, such as that caused by a chronic illness, cancer or a mental disorder. This type of sensations is complicated to treat and often require an individualized follow-up by a team specialized in the treatment of pain. However, the discomfort that originates after a surgical intervention is usually different: acute and specific, frequently related to the fact of the operation and the anxiety generated around this process.
Paul Myles and Ian Power of the Department of Anesthetic and Preoperative Medicine at Alfred Hospital and Monash University, both in Melbourne (Australia), have reviewed the most appropriate therapies to alleviate postoperative pain. The work indicates when to use an analgesic orally or intravenously when to discard one type of drugs and employ others and what kind of processes respond better to one therapy or another.
In the first place, these experts recommend that after an operation the most immediate thing is to measure the pain through a visual or verbal scale established for these patients. In addition to being useful to identify the needs of the patient, the evaluation of the degree of pain could serve to assess the appearance of complications such as bleeding, infection or paralytic ileus.
The next step is to determine if the operated person continues fasting for a few hours or can take something by mouth after the invasion. If so, it is preferable to opt for opioids in tablets instead of injectables. The dosage of these drugs should be prescribed individually because the needs between each person vary greatly. Also, we must bear in mind that patients over 60 years of age need a 20% lower amount per decade of age.
The paracetamol is the ideal drug for persons subject to a lower or intermediate intervention, which can be performed on an outpatient or require many days of hospitalization. This can be joined any other non-steroidal anti-inflammatory (or a COX-2 inhibitor) and also add tramadol for significant pain.
According to these experts, you can use 1-1.5 g of paracetamol (intravenous, oral or rectal) four times a day. The maximum recommended dose is 5 gr per day for less than five days. Regarding non-steroidal anti-inflammatory drugs (NSAIDs), the article explains that the main drawback of these drugs is their side effects, especially in the elderly. On the one hand, the increased risk of bleeding of NSAIDs and the greater tendency of COX-2 of thrombotic complications makes these specialists decide on naproxen as a complementary therapy to paracetamol in high-risk patients.
Regarding the dose, they recommend 250 mg orally three times a day for naproxen, and 50 mg orally or rectally twice daily for diclofenac. These doses should be reduced to a period of fewer than five days if there is dehydration, renal failure or if the patient is elderly.
For its part, tramadol offers effective analgesia in people undergoing minor or intermediate intervention. It can be used as a complementary therapy to paracetamol taking into account that it is contraindicated in advanced kidney failure, epilepsy, carcinoid syndrome (symptoms that are usually observed in people with carcinoid tumors: in the small intestine, the bronchi ...) and in pheochromocytoma (a tumor of the adrenal gland). The optimal amount will be 100 to 150 mg orally four times a day.
Finally, and as another mutual option in a minor intervention, one can resort to oxyco done, a type of opiate, in doses of 5 to 10 mg every four hours.
As for the advice for those patients subjected to more complex interventions, these experts recommend the use of the above drugs along with morphine.
“Opioids are effective analgesics in the postoperative period and are the main drugs for medium or strong pain […] Intravenous analgesia is now the standard method for these patients. This technique improves pain control compared to intermittent administration of opiates, “say the authors of this report.
The steps advised by these experts are the intraoperative administration of morphine and the addition of 1-2 mg in the recovery room to control pain before moving the patient to the plant. If a local anesthetic block has been made, the dose of morphine will be lower.
If an anesthetist can control the patient in the plant, the amount of morphine can be 2 mg in an intravenous bolus. But if this specialist cannot be present, the use of 0.10 mg per kilo of weight is recommended intramuscularly or subcutaneously every 2 hours as needed.
If the intensity of the pain is surprisingly high and does not yield with analgesics, the surgical team should be notified to assess the patient.
Analgesia (intravenous, intramuscular or subcutaneous) will be maintained 24 to 72 hours after the intervention to subsequently undergo oral treatment, similar to that of minor operations.
The most important side effects of opioids are depression of the respiratory system, sedation, nausea, vomiting and the inhibition of gastrointestinal motility. For this reason, it is necessary to monitor and monitor these patients to avoid excessive sedation and the appearance of these alterations.