QuickTime™ and a
decompressor decompressor
are needed to see this picture.
are needed to see this picture.
2. Knowledge of Pain
3. Knowledge of the
Standard of Care
Knowledge of Self QuickTime™ and a
decompressor
are needed to see this picture.
1. Pain Assessment
“Moderate” surgery
Hip replacement
Hysterectomy
Paracetamol/NSAID +
Epidural L.A, opioid or combination
Maxillofacial
or systemic opioids (PCA)
Paracetamol/NSAIDs/weak opioids
Wound infiltration with l.a. and/or
Peripheral nerve block Rawal,Reg Anes Pain Med,24:1:71,1999
Knowledge of Standard of
Care
QuickTime™ and a
decompressor
are needed to see this picture.
* Subjective
* Self-Report
QuickTime™ and a
decompressor
are needed to see this picture.
Why do we need to control pain?
GIT/GUT
•Ileus, nausea, vomiting CARDIOVASCULAR
•Urinary retention, uterine inhibition • Increased plasma catecholamines
•Myocardial ischemia
RESPIRATORY
MUSCLE
•Atelectasis
Restless
Immobility •Pneumonia
PAIN •hypoxia
CNS
•Anxiety METABOLIC
•Depression •Increased catecholamines, cortisol
•Sleep disturbance • decreased insulin
Assessment of Pain QuickTime™ and a
decompressor
are needed to see this picture.
• Physiologic/Biologic Parameters
• Behavioral Observations
Patient & Family Education QuickTime™ and a
decompressor
are needed to see this picture.
• Presurgical (Preoperative)
– Teach the patient and the family members what to
expect about pain and pain management and how pain
is assessed
• Importance of ongoing assessments
• Presurgical (Preoperative)
– Patient should understand his/her own role in
managing pain
• Cooperation needed during assessment
• “staying on top of pain”
• Importance in communicating information about their status
of pain
• Presurgical (Preoperative)
– Provide written materials whenever possible
QuickTime™ and a
decompressor
are needed to see this picture.
Patient & Family Education QuickTime™ and a
decompressor
are needed to see this picture.
QuickTime™ and a
decompressor
are needed to see this picture.
Patient & Family Education QuickTime™ and a
decompressor
are needed to see this picture.
• PACU (Postoperative)
– Reinforce the following points:
• The reality of postoperative pain
• Cooperate with anesthesia team
– Explain why frequent assessments are necessary
– Provide instruction on how to report pain
– Encourage communication
• Ineffective pain relief measures
• Increasing pain
• Pain other than surgical site QuickTime™ and a
decompressor
are needed to see this picture.
• Surgical Unit
– Teach the patient how pain will be assessed
– Explain the importance of managing pain in a
timely manner
– Explain to the patient that there are options
for breakthrough pain
– Make the patient aware of alternative
therapies
QuickTime™ and a
decompressor
are needed to see this picture.
Documentation
• Presurgical Planning
Clearly document the following:
– Patient’s comprehension of information
– Which pain scale was taught
– Screening for absence or presence of pain QuickTime™ and a
decompressor
are needed to see this picture.
Documentation
• Admission and Surgery
– Pain score at regular intervals
– Pain intervention and response to the intervention
QuickTime™ and a
decompressor
are needed to see this picture.