Postoperative pain can be experienced during wound healing, at a time when an incision is open or, if an incision is not made, when a new incision is being made as necessary for the treatment. When a wound or surgical incision is painful, it may diminish the function of an arm; it may also adversely affect one's quality of life.
Approximately 41.1% of adults receive surgeries in the United States. Postoperative pain (40.2%) is the third most common pain that one experiences within the first 30 days after surgery with 24.3% of the patients reporting at least some pain. These pain scores are higher when patients have one or more comorbidities.
This article summarizes potential surgical risk factors influencing postoperative pain. This article also discusses common treatments to treat pain after surgery. Additional risk factors for postoperative pain are discussed as a part of the overall surgical treatment planning strategy.
The major clinical presentation of pain and chronic postoperative pains may be treated using a multifactorial management approach. This approach takes into account both the patient's baseline state (demographics, psychiatric history, comorbidities and risk factors) and the characteristics of the individual pain (pain intensity and distribution). The pain and fatigue symptoms are often intertwined, sometimes with other factors such as psychological and social stress.
Currently, most current treatment of pain has not been successful even though this is a large problem that is being seen in the pediatric population. Pain can be treated with an aqueous solution of ketorolac topical cream. In order to be successful in reducing pain, the cream needs to be administered regularly and a schedule has to be followed. This is especially true for pain associated with surgical operations.
The most common treatment for postoperative pain is strong opioids and ketorolac. In acute pain, nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used. In chronic pain, psychosocial interventions or behavior modification techniques are usually included. A combination of medications such as analgesics, anti-inflammatory agents and muscle relaxants are usually most effective. Cognitive behavioral therapies may help some people with chronic pain.
The analgesic and anti-inflammatory effects of ketorolac and ketorolac tromethamine were not confirmed in post-operative pain in paediatric patients, but the results suggest the possible utility of ketorolac in paediatric patients with post-operative pain (NCT02272479).
Pain is the most common primary cause of postoperative pain and discomfort, and nearly half of that would be attributed to pain that is not due to an identified cause. It is important to differentiate between pain that is due, attributed, and unexplained.
A survey of 11 American hospitals showed an average age of 64 years for postoperative pain after a [surgical procedure] but 64 years for postoperative fatigue after a [surgical procedure]. People are living longer; younger people may live longer after a [surgical procedure]. Findings from a recent study demonstrates that postoperative pain cannot be ascribed to age alone.
Therapeutic administration of ketorolac provides effective analgesia with few side effects in the early postoperative period. However, the use of this product is associated with an increased risk of infection and the requirement for hospital care at discharge as compared to the use of nonadverse-effect postoperative pain medication.
Patients suffering from osteoporosis are prone to an increased risk of experiencing side effects of ketorolac use. Appropriate monitoring of side effects of ketorolac use in osteoporotic patients should be a routine part of its use.
There are many reports of postoperative nausea and vomiting after ketorolac application, but the mechanisms underlying these adverse effects remain unknown. We hypothesize that ketorolac-induced vomiting results from stimulation of vagal afferent fiber pathways, which cause an increase of gastric mucosal permeability.