Postoperative Pain Management

Nursing Knowledge

Postoperative Pain Management

Effective pain control after surgery involves assessing pain levels, administering prescribed medications, and employing non-pharmacological methods. Nurses monitor patient/client responses to pain interventions, educate patients about pain management strategies, and collaborate with the healthcare team to adjust pain management plans as needed. Understanding various pain management approaches and tailoring them to individual patient needs are essential skills for nurses in clinical practice – and for the NCLEX exam.

Last updated: October 9, 2024

What goes into managing pain after surgery?

Effective postoperative pain control facilitates early mobilization, reduces hospital length of stay and improves client satisfaction. Opioid medications remain central to pharmacologic postoperative pain management. However, given growing awareness of the morbidity and mortality associated with opioid use disorders, best practice increasingly supports a multimodal and multidisciplinary team approach.

Preoperative planning

Planning for pain management should begin in the preoperative period. Factors to consider include:

Type of procedure anticipated
Client age
Comorbidities
History of chronic pain, depression, chronic opioid use
Social factors
Client openness to or current use of alternative and complementary therapies

Nursing considerations about pain management

Pain scale indications should be included in each drug order for pain control. Select drugs based on the client’s reported pain level. Be sure to document pain level assessment to validate selection and timing of pain medications.
Always adhere to ordered reassessment schedule to verify efficacy of pain control. Timelines differ based on the class, dose, and route of medication administered.
Pain medication may be scheduled or ordered PRN (‘as needed’). Review orders and assess client pain frequently to ensure adequate pain control through use of PRN medications.

Patient-controlled anesthesia (PCA) pump

A PCA pump allows clients to self-manage pain by pressing a button for medication or administering a constant low dose with optional supplemental bolus doses initiated by the client. Nursing tasks:

Assessment, pump maintenance, and client education
Monitor carefully for signs of oversedation.
Educate that the button may be pressed by the client only, not by family members or other visitors.

Systemic pharmacologic pain management

Most postoperative clients will have orders for multiple pain medications.

Rule: “Start low and go slow.”

Utilize the least sedating medication and lowest dose that achieves adequate pain control. If the client continues to experience pain, advance to the next class or dose, or combine classes as ordered.

Medications in order of least to most sedating:

Tylenol and NSAIDs
Gabapentin
Oral opioids
IV opioids

How to relieve pain after surgery naturally

Natural methods to relieve postoperative pain

When considering natural methods, it's important to discuss them with the healthcare team to ensure they are safe and appropriate for the patient's specific situation, especially in the postoperative context. These methods are often most effective when used as part of a comprehensive pain management plan that may also include medications.

Physical therapy, movement, early ambulation
Heat or cold therapy
Rest and relaxation techniques
Massage, acupressure (never on surgical wounds)
Aromatherapy (mindful of allergies)
Herbal supplements

Multimodal approach

Layered interventions, tailored to each client’s characteristics, comorbidities, and risk factors, improve pain management. Nurses can encourage the multidisciplinary team to plan for multiple modalities:

Systemic pharmacologic therapy
Local, intra-articular, or topical techniques
Regional anesthetic techniques
Neuraxial anesthetic techniques
Nonpharmacologic therapies

How to get rid of gas pain after surgery

Post-surgical gas pain is common and uncomfortable for patients. Encourage your nursing clients to move and walk around as soon as their condition allows. Comfortable positioning and hydration, as well as warm compresses, deep breathing exercises, and dietary adjustments can help as well.

How to treat nerve pain after surgery

Prescribed pain medications may include neuropathic pain agents like gabapentin or pregabalin: Monitor for effectiveness and side effects.
Non-pharmacological interventions include physical therapy, heat and cold therapy, and relaxation techniques.

Pain: Nursing Diagnosis & Scales

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