Postoperative pain assessment should not be "the same", and postoperative pain should be treated correctly!

Pain assessment includes an evaluation of pain intensity, pain causes and assess changes in vital signs of possible concurrent assessment of the effects and side effects of treatment, such as evaluation of patient satisfaction

Pain assessment includes an evaluation of pain intensity, pain causes and assess changes in vital signs of possible concurrent assessment of the effects and side effects of treatment, such as evaluation of patient satisfaction

However, under normal circumstances, the mechanism of injury is not obvious

Pain intensity scoring method Pain intensity scoring method Pain intensity scoring method

Numerical Evaluation Scale (NRS): Use 0~10 to represent different degrees of pain: 0 means no pain, 1~3 means mild pain (pain does not affect sleep), 4~6 means moderate pain, 7~9 Severe pain (inability to fall asleep or waking up during sleep), 10 means severe pain

Numerical Evaluation Scale (NRS): Use 0~10 to represent different degrees of pain: 0 means no pain, 1~3 means mild pain (pain does not affect sleep), 4~6 means moderate pain, 7~9 Severe pain (inability to fall asleep or waking up during sleep), 10 means severe pain

Visual analogue scale (VAS) : A 10cm long scale, one end represents no pain, and the other end represents severe pain

Source: fpmx.

Source: fpmx.

Facial expression score: consists of six facial pictograms with different expressions ranging from smile or happiness to tears

Principles and Difficulties of Pain Assessment Principles and Difficulties of Pain Assessment

In the principles of pain assessment, the intensity of pain at rest and exercise needs to be assessed

In the principles of pain assessment, the intensity of pain at rest and exercise needs to be assessed

At the same time, the sudden severe pain should be evaluated immediately, and the pain should be treated and evaluated again in time

However, in the process of pain assessment, there are also some difficulties, such as the pain intensity score in the active state, the nature of pain, and the time point of postoperative pain assessment

Pain intensity score in the active state

Pain type fluctuations

Pain type fluctuations

Active pain scoring tools can refer to the FAS recommended by the Australian Victorian Quality Control Committee VQC and ANZCA

Active pain scoring tools can refer to the FAS recommended by the Australian Victorian Quality Control Committee VQC and ANZCA

The nature of the pain
.
The nature of pain is directly related to the choice of analgesic drugs and the formulation of analgesic plans.
Therefore, the nature of pain needs to be accurately described in pain assessment.
This is another major difficulty in pain assessment.
The assessor needs to patiently explain various pain characteristics.
Features (such as acupuncture-like sensation, and the pain occurs quickly, disappears quickly, and the location is clear), and the nature of the pain and the cause of the pain need to be considered comprehensively, such as various types of fractures, and the assessment at the time of admission is mostly continuous fixation Pain and tenderness are obvious; orthopedic postoperative pain is mostly fullness, throbbing, persistent pain, etc.
; neuropathic pain is mostly electric discharge, acupuncture, burning, knife cutting, accompanied by hyperalgesia, and allodynia
.
The nature of the pain
.

The time point of postoperative pain assessment
.
There is no uniform time point for postoperative pain assessment.
There are guidelines recommending to evaluate the patient's pain every 2h within 6h after surgery, and every 4h from 6 to 24h after surgery; after 24h, it is recommended to assess the patient's pain every 12h
.
Taking into account the clinical operability and the characteristics of postoperative pain, the clinic can determine the time point of postoperative pain assessment based on its own actual situation
.

The time point of postoperative pain assessment
.
There is no uniform time point for postoperative pain evaluation.
There are guidelines recommending that the patient's pain be evaluated every 2h within 6h after surgery, and every 4h from 6 to 24h after surgery; after 24h, it is recommended to evaluate the patient's pain every 12h
.
Taking into account the clinical operability and the characteristics of postoperative pain, the clinic can determine the time point of postoperative pain assessment based on its own actual situation
.
The time point of postoperative pain assessment
.

During the pain assessment process, if the patient has sudden severe pain (burst pain), it needs to be evaluated immediately.
After drug treatment (in principle, 5~15min after intravenous administration, 1h after oral administration), the treatment effect should be evaluated.
The dynamic process of evaluation-treatment-re-evaluation
.
The evaluation and treatment of burst pain should be recorded (Attached Table 2).
Patients with patient-controlled analgesia should know the number of invalid compressions and whether they should seek other analgesic treatment
.
In a multidisciplinary team, clinical pharmacists need to cooperate effectively with nurses in the ward to timely discover the patients’ inadequate analgesia, adverse drug reactions, etc.
If the patient has more than 3 outbreaks of pain within 24 hours, the clinical pharmacist needs to discuss the pain with the doctor The reasons for poor control need to be adjusted if necessary
.

During the pain assessment process, if the patient has sudden severe pain (burst pain), it needs to be evaluated immediately.
After drug treatment (in principle, 5~15min after intravenous administration, 1h after oral administration), the treatment effect should be evaluated.
The dynamic process of evaluation-treatment-re-evaluation
.
The evaluation and treatment of burst pain should be recorded (Attached Table 2).
Patients with patient-controlled analgesia should know the number of invalid compressions and whether they should seek other analgesic treatment
.
In a multidisciplinary team, clinical pharmacists need to cooperate effectively with nurses in the ward to timely discover the patients’ inadequate analgesia, adverse drug reactions, etc.
If the patient has more than 3 outbreaks of pain within 24 hours, the clinical pharmacist needs to discuss the pain with the doctor The reasons for poor control need to be adjusted if necessary
.

In short, good postoperative pain control can reduce postoperative stress, weaken postoperative immunosuppression , accelerate the recovery of intestinal function, and promote early recovery of patients
.
Clinics can strengthen postoperative pain management through the cooperation of multidisciplinary team members such as anesthesiologists, surgeons, specialist nurses, and clinical pharmacists
.

In short, good postoperative pain control can reduce postoperative stress, weaken postoperative immunosuppression , accelerate the recovery of intestinal function, and promote early recovery of patients
.
Clinics can strengthen postoperative pain management through the cooperation of multidisciplinary team members such as anesthesiologists, surgeons, specialist nurses, and clinical pharmacists
.
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references

references

1.
Clinical pharmacist guidelines for postoperative pain management

1.
Clinical pharmacist guidelines for postoperative pain management

2.
Postoperative Pain Management – ​​Good Clinical Practice.
https:// class="s1" >2.
Postoperative Pain Management – ​​Good Clinical Practice.
https:// class="p1">3.
Liu Yanqing, Cui Jianjun.
Practical Pain Science[M].
Beijing: People's Medical Publishing House, 2013:1.

3.
Liu Yanqing, Cui Jianjun.
Practical Pain Science[M].
Beijing: People's Medical Publishing House, 2013:1.

4.
Leng Xisheng, Wei Junmin, Liu Lianxin, et al.
Expert consensus on perioperative pain management in general surgery[J].
Chinese Journal of General Surgery, 2015, 30 (2): 166-173.

4.
Leng Xisheng, Wei Junmin, Liu Lianxin, et al.
Expert consensus on perioperative pain management in general surgery[J].
Chinese Journal of General Surgery, 2015, 30 (2): 166-173.
The consensus

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