Introduction
Every surgical procedure can subsequently be accompanied by pain, the so-called “postoperative pain”. Normally, pain is a warning function of the body to protect itself from damage. Since pain is artificially generated during an operation, it has no warning function in this case.
Postoperative pain is very unpleasant for the patient. In addition, it is now known that they have an unfavorable influence on the healing process. For these reasons, modern medicine strives to eliminate postoperative pain as far as possible.
Aims of the postoperative pain therapy: The greatest possible freedom from pain gives the operated patient the possibility to perform physiotherapeutic and respiratory exercises much more effectively than under pain. This contributes to the patient being able to sit up, stand up and walk earlier. Post-operative pain therapy also aims to prevent a weakening of the immune system through pain and thus strengthen the immune system’s defenses against infections. The cardiovascular system and the gastrointestinal tract are also negatively affected by pain, so that a successful postoperative pain therapy can also have positive effects here.
Before the operation
The foundation for a successful postoperative pain therapy is already laid before the operation, during the informative discussion with the anaesthetist. The doctor explains to what extent pain can be expected after the respective operation and how it is usually treated. This enables the patient to adjust accordingly and thus reduce anxiety.
With regard to pain therapy during and after the operation, doctors should know whether the patient regularly takes painkillers or consumes alcohol or other drugs. This may require the use of other drugs and/or dosages. If severe pain is expected during surgery, blocking regional pathways may be useful in addition to the particular method of anesthesia.
Causes of pain
In most cases, the development of postoperative pain is closely related to the execution of skin incisions and the relocation of tissue parts. During a surgical procedure, strong forces can act on the surgical site, traumatizing the tissue. In addition, postoperative pain is often caused by reduction maneuvers during the procedure.
In particular, the displacement of bone and bone fragments can severely affect the surrounding tissue and thus lead to postoperative pain. In the course of some surgical procedures, it is also necessary to drain off any wound secretions that may have formed via a drainage. This is a thin tube with a small container at the end.
The drainage is inserted during the operation and must remain in the operating area until it hardly transports any secretion. Many patients with postoperative pain report a significant alleviation of symptoms after removal of the drainage. However, postoperative pain can also occur outside the actual surgical area.
The reason for this can be incorrect or simply uncomfortable positioning during the operation. In addition, post-operative pain can occur in the area of the indwelling cannulae (PVC) through which the patient is supplied with fluid and/or medication. Artificial respiration during the operation, or rather the insertion of the ventilation tube (tube), can also lead to postoperative pain.
The affected patients often suffer from sore throat, difficulty swallowing and hoarseness. Various systems are available in everyday clinical practice to determine postoperative pain. Among the best known scales used to measure postoperative pain are the Visual Analog Scale (VAS), the Verbal Rating Scale (VRS) and the Face Rating Scale.
With the help of the Visual Analogue Scale, postoperative pain can be recorded easily and quickly. The presence of a physician is not necessary to determine the patient-specific pain intensity. With this system, an approximately 10 cm long line, divided into 1 cm steps, is used to record pain.
The end points of the line stand for “no postoperative pain” to “the strongest pain imaginable”. Patients are usually asked to define their pain perception using this scale every day after the operation. With this system, post-operative pain can be assessed using numbers.The patient is asked to assign a number between 1 and 10 to the complaints he/she feels.
The number 1 stands for “no pain” and the number 10 symbolizes the “worst pain imaginable”. A variation of the numerical rating scale is the so-called “verbal rating scale”, where the patient is asked to assign his individual postoperative pain to the levels: no pain, mild pain, moderate pain, severe pain or maximum imaginable pain. The so-called “Face Rating Scale” is mainly used in pediatrics.
It is a simple symbol-based tool for assessing postoperative pain. The actual scale has a smiling, pain-free face on the left side. The right side, on the other hand, depicts a crying, painful face.
The assessment of post-operative pain can be made by the patient himself or by observing the patient’s facial expressions. Pain scales are still considered to be the ideal method for estimating postoperative pain in particular and pain in general. Especially with regard to the treatment of pain phenomena and the patient-specific dosage of pain medication, their regular execution seems to be indispensable.
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