Controlled Pain, Speedy Recovery

Post-operative pain can be managed effectively using intravenous infusion.

Surgery of any kind can be a daunting prospect.

But in reality what most people fear most is not the procedure itself – since they are almost always under a general anaesthetic– but the pain that they expect will follow.

Post-operative pain may vary from one person to another but is generally recognised as an excellent indicator as to how a patient’s recovery is progressing.

Good pain relief is now understood to be not just essential for comfort and relief – it actually helps the patient to recover more quickly.

After chest surgery, for example, patients are less likely to develop a chest infection if they are able to breathe deeply and cough easily without being gripped by pain.

Similarly with major orthopaedic surgery – such as a hip replacement – the risk of a potentially life-threatening deep vein thrombosis (a clot which forms in the lower leg but can be fatal if it breaks loose and travels to the lungs) is significantly reduced if the patient can move around freely.

Again, this is only possible if their pain is well-controlled.

There are various techniques for administering painkilling drugs after surgery.

Conventional methods involve injections into a vein or muscle – such as the buttock.

Intravenous injections, those that go straight into the vein, work within two to three minutes but intramuscular jabs take longer – about 15 to 20 minutes.

More common for severe post-operative acute pain is a technique called intravenous infusion.

This is where a programmable machine continuously infuses a strong painkilling drug, usually an opioid like morphine, into a cannula inserted into a vein in the hand or arm.

The amount of painkiller required is controlled by a nurse and intravenous infusion is normally used for one to two days after an operation.

Modern infusion technology, such as some of the products supplied by CME Medical, is so sophisticated that it allows responsibility for administering pain-relieving drugs to be passed to patients themselves.

This is called Patient Controlled Analgesia (PCA) and it consists of a pump containing morphine that is linked to a handset with a button on it.

At the press of the button, the patient is able to give themselves a dose of morphine into a cannula in their vein.

The pump is programmed to only allow a dose every few minutes and is set up so that a patient cannot take too much at one time.

But it’s important that the equipment is used correctly. Patients with acute upper body pain, for example, need to press the button to provide a morphine boost if they feel the need to breathe deeply, cough or move after their operation.

“Pain management has progressed a great deal in recent years,” says Ginina Houghton, who leads CME Medical’s Clinical Team.

“The big change has been that patients now get control over their own pain management wherever possible,” continues Ginina.

But it’s not without its dangers. The major life-threatening complication of opioids is respiratory depression – where the lungs cannot provide enough oxygen for the rest of the body.

The incidence of severe respiratory depression with patient-controlled analgesia pumps has been reported to be up to one per 10,000 patients, although these events are usually associated with an error in management rather than faulty equipment.

In fact, the Bodyguard pumping mechanism supplied by CME Medical features a lockable keypad to prevent inadvertent button pressing, a built-in log that records data on pump use and smart software – called MediGuard™ – which automatically sets a toxicity ceiling, based on the patient’s weight, to prevent excess drug delivery.

But how do nurses and doctors know how much pain each patient is in?

Most hospitals use simple scales known as the verbal rating scale and the numerical rating scale.

The first relies on the patient describing their suffering on a scale of nought to three (where zero is no pain, one = some pain, two = considerable pain and three = severe pain).

The numerical rating scale scores pain on a broader zero to ten scale, with zero being no pain at all and ten excruciating pain.

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