Severe pain from a large incision in a frail patient may require high
doses of intravenous opiate drugs leading to elective postoperative endotracheal
intubation and ventilation until the patient is stable. This approach should be
used if the patient is likely to become hypoxic through struggling in pain if
other methods of pain relief are not effective. Other methods of pain relief,
properly used, can usually prevent the need for mechanical ventilation even in
very major thoracic and abdominal surgery. Acute pain relief teams, using
continuous methods of pain relief in high dependency areas well equipped with
monitoring, are becoming a routine feature of the postoperative care in both
the USA and the UK. Regular intramuscular morphine injection, supplemented by
anti-inflammatory analgesic drugs and, possibly, a regional anaesthetic block,
are effective treatment for the majority of surgical patients. Each patient
should have a pain relief measurement chart for regular assessment with other
routine nursing observations. Special methods of pain relief used under close
supervision are:
• continuous epidural anaesthesia with opiate or local anaesthetic
drugs;
• continuous intravenous opiate analgesia;
• patient controlled analgesia by injection intravenously or
epidurally of opioid analgesia. The patient is trained to give a bolus dose of
drug by pressing a control button on a machine whose functions have been
regulated by the medical staff. The strength, frequency and total dose of drug
in a given time are all limited by computer.
Effective
postoperative pain relief encourages early mobilisation and hospital discharge.
Simple
analgesic agents
In minor surgery, and when the patient is able to eat after major
surgery, aspirin and paracetamol are often the only drugs necessary to control
pain. Fear of metabolic acidosis and Reye’s syndrome of hepatotoxicity in
children have