Additional Material

Peri-Operative Pain Control

Incidence

• Globally, 313 million estimated surgical procedures.
  • 54.1 million inpatient in US
  • 53 million outpatient in US
• Types of surgeries (inpatient only)
  • Cesarean section (1,300,000)
  • Total knee replacement (719,000)
  • Fracture reduction (671,000)
  • Hysterectomy (498,000)
  • Coronary artery bypass graft (395,000)
  • Total hip replacement (332,000)
• 80% of surgery patients report pain
• 75% to 88% report "moderate to severe" pain after surgery
• Undertreated pain results in increased:
  • Length of stay
  • Readmission rate
  • Time before ambulation
  • Risk of chronification

Assessment

• Assessment may occur via numerous mechanisms
  • Numeric rating scale (NRS)
  • Wong-Baker Faces Scale ("Faces")
  • Visual analog scale (VAS)
  • Clinically Aligned Pain Assessment (CAPA)
  • Pain, Enjoyment, General Activity (PEG)
• Pain assessment should occur frequently during or immediately following a surgical procedure as well as following a treatment (non-pharmacologic or pharmacologic)
  • Every 15 minutes while in step-down
  • Every 60 minutes while on medical surgical floor
  • Every 2-4 hours following first 24 hours after surgery
• Equally important is the assessment of sedation, especially in the presence of opioids
• Pain assessment without action is useless in the presence of moderate or severe pain

Reference

Chou R, et al. J Pain 2016;17(2):131-157

Non-Pharmacologic

Non-pharmacologic prevention and management strategies are equally as important as pharmacologic treatment strategies

1. Pre-operative education results in
   • Decreases pre-operative anxiety
   • Enhanced use of non-opioid modalities
   • Decreases pain report
2. Electroanalgesia
3. Acupuncture
4. Massage
5. Guided imagery
6. Physical therapy
7. Mindfulness based relaxation
8. Application of heat/ice

Reference

Chou R, et al. J Pain 2016;17(2):131-157

Pharmacologic

Pharmacologic management of post-operative pain

1. Prevention
   • Before first incision
   • During procedure
2. Post-operative management
   • Opioid analgesics
   • Nonopioid analgesics

Enhanced Recovery After Surgery

What is ERAS?

Test Your Knowledge

Which of the following is/are included in Enhanced Recovery After Surgery (ERAS) programs?