Peri-operative Analgesia

Peri-operative analgesia should be administered where pain either already exists or the procedure could induce noxious stimuli.

Peri-operative analgesia should be considered standard practice, and pain should not be considered a natural immobilisation agent. Reduction of pain greatly assists recovery from surgery.

Process

The first step to improving pain management is to have a repeatable process for assessment.

Assessment

Whilst there is difficulty assessing the degree of pain in patients that can not speak, techniques such as Glasgow Composite Pain Scale can become a rapid pain assessment tool in clinical practice. ¹⁸

Pre-emptive

Instigate analgesic actions prior to noxious stimuli to reduce the sensitisation of neural pathways to painful stimuli

Anxiolytic agents

Acepromazine and benzodiazepines can augment the effect of opiate medications by decreasing sympathetic drive in the patient.

Opioids

Opioids offer multiple beneficial effects including analgesia and reduced requirement for anaesthetic agents.

Alpha-2 agonist

(Medetomidine, dexmedetomidine) Decrease anaesthetic drug requirements and can augment the effects of other analgesics.

Multimodal

The administration of several analgesic agents with different modes of action e.g. opioids, local anaesthetics, NSAIDs, will target different areas of the nervous system. This improves the efficacy of pain control, reduces the dose of each agent and therefore reduces undesirable side effects.

Intra-operative

Maintain analgesia through the surgery period

Post-operative

A painful patient is likely to suffer a poor recovery especially with modern induction and maintenance agents that are rapidly metabolised. Providing analgesia until the patient is no longer experiencing pain is essential for a smooth recovery.