Drugs used for pain management in gastrointestinal surgery and their implications

Table 1 Preoperative assessment and education of patient[20]

Establish good relationship with patients’ relatives
Take pain history
Teach patient about pain assessment and management plan
Inspect concerns and handle misinterpretations regarding pain medications, adverse effects and dependence
Create a plan for postoperative analgesia in alliance with patient depending on type of surgery, anticipated severity of postoperative pain, co morbidities, the risk-benefit and expense of techniques, patient’s preferences
Patient selected appropriate pain assessment tool (e.g., Numeric Rating Scale, Visual Analog Scale)
Mention the patient’s selected pain assessment tool
Teach patient and relatives about their responsibilities

Table 2 Postoperative assessment and education of patient[20,21]

Examine multiple indicators of pain, including (1) Patient perceptions; (2) Cognitive attempts to address pain; (3) Behavioural responses (e.g., reduced mobility, sleeplessness, anxiety, depression); and (4) Physiological changes (vital signs: Tachycardia, hypertension)

Accept patients self-report, and only replace behaviour and/or physiological changes when he is unable to communicate

Assess pain at rest and during activity (e.g., moving, coughing)

Measure pain frequently during the early post operative period: At regular intervals, consistent with type of surgery and severity

Document pain intensity and its response to any interventions and adverse effects

Promptly assess instances of sudden intense pain

Think of reasons or any disparities between patients’ self-report of pain and behaviour. As patient may be denying pain due to casualness or worry of inadequate pain relief

Special attention to special populations, and be aware of hurdles of effective communication (e.g., language issues, mental, cognitive or hearing impairments, etc)

Revisit the management plan, if needed

Before discharging patient, review interventions implied and their efficiency; give specific and detailed discharge instructions for pain management at home