Analgesia in PACU: indications, monitoring, complications.
The correct treatment of postoperative pain, in the early period immediately following surgery, is founded on the following four principles: 1-correct diagnosis of the source and magnitude of nociception; 2-understanding of the relationship of ongoing nociception and other components of pain including anxiety, ethnocultural components, meaning, prior experience; 3-treatment by establishment and maintenance of drug level at active sites to achieve and maintain analgesia and anxiolysis as appropriate; 4-continued re-evaluation of the therapy and refinement of the approach. The PACU standard of cure requires a strict accordance between intra and postoperative analgesia. It requires "proactive preoperative plan" that includes: preoperative patient evaluation; discussion with a single patient on different treatment options; patient and family education; pre-emptive measures as indicated; intra-operative multimodal analgesia; a correct triage of analgesia, just after initial evaluation of vital parameters in PACU; re-evaluation of analgesia plan, if analgesia is inadequate; a new titration, intravenous or epidural way, in order to achieve a stable VAS < 3; plan a new analgesia scheme or confirm a preoperative plan; control of adverse events, related to analgesia plan (gastric bleeding and/or bleeding of the surgical wound site, NSAIDs-induced renal damage, respiratory depression, delayed canalisation, nausea, vomiting, excessive sedation, difficulty in bladder emptying, itchiness); a transmission of analgesia plan to ward nurses; a control quality for verify at prefixed times patients satisfaction level, analgesia performed, adverse effects percent, analgesia related, plan variations percent.
Savoia
Gennaro
G
Service of Paediatric Anaesthesia and Reanimation-Maternal-Child Department, A.O.R.N. A Cardarelli-Naples, Napoli, Italy. gennarosavoia@libero.it
Gravino
Elvira
E
Loreto
Maria
M
Erman
Alfredo
A
D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D017408:Guidelines as Topic; D006801:Humans; D008991:Monitoring, Physiologic; D010149:Postoperative Pain / Q000188:drug therapy* / Q000503:physiopathology; D011997:Recovery Room
D000700:Analgesics