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Chapter 7 - Perioperative pain management

from Section 1 - General

Published online by Cambridge University Press:  05 September 2013

By
Anne Marie McKenzie-Brown
Edited by
Michael F. Lubin ,
Thomas F. Dodson  and
Neil H. Winawer
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Neil H. Winawer
Affiliation:
Emory University, Atlanta
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Summary

Overview: Benefits of postoperative pain control

Acute pain, highlighted by Marks and Sachar's 1973 landmark article on the undertreatment of pain in inpatients, has been discussed in the medical literature for many years [1]. Despite the advances made, the attention given, the development of national guidelines on the evaluation and treatment of acute pain, and adoption of pain as the “fifth vital sign,” postoperative pain is still undertreated [2,3]. A 2003 survey of postoperative patients in the USA showed that 82% of patients reported postoperative pain lasting until 2 weeks after discharge; 39% of these described the pain as severe [3].

Both over- and undertreatment of pain can result in negative consequences in the outpatient perioperative setting [4,5]. Untreated pain results in stimulation of the stress response and increased sympathetic activity which can then lead to increased myocardial demand and systemic hypercoagulability [3,5]. Inactivity, inability to take deep breaths and other activities limited by pain may increase the chance of developing postoperative ileus, deep vein thrombosis and atelectasis [3]. Undertreated pain is the most common reason for delayed discharge home following ambulatory surgery and it is often a reason for unanticipated hospital admission [5,6].

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 61 - 69
Publisher: Cambridge University Press
Print publication year: 2013

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