ACUTE PAIN CONTROL AND ACCELERATED POSTOPERATIVE SURGICAL RECOVERY
Section snippets
PAIN CONTROL AND THE SURGICAL STRESS RESPONSE
A common feature shared by all surgical patients is the widespread changes in several biologic cascade systems, including a predominance of catabolic hormones, activation of cytokines, complement, arachidonic acid metabolites, nitric oxide, and free oxygen radicals, all of which secondarily may lead to organ dysfunction and morbidity. Pain may obviously be considered as another neurophysiologic response to surgery but with its own secondary effects on biologic functions. Effective treatment of
PAIN CONTROL AND SURGICAL OUTCOME
Despite extensive data to demonstrate beneficial physiologic effects in specific organ dysfunctions and outcomes (Table 1) by efficient analgesia, the anesthetic and surgical literature has shown inconsistent results on overall postoperative morbidity.
THE MULTIMODAL APPROACH TO ACCELERATE POSTOPERATIVE RECOVERY
The pathogenesis to postoperative morbidity, need for hospitalization, and convalescence involves several factors (Fig. 1).16 Pain relief per se has not represented a major breakthrough to improve surgical outcome, as discussed earlier. Nevertheless, effective functional postoperative pain relief has a great potential to improve postoperative outcome, because pain-relieving techniques have beneficial physiologic effects on different organ systems in the postoperative period. To enhance progress
SUMMARY
Postoperative pain relief continues to demand our awareness, and surgeons should be fully aware of the potential physiologic benefits of effective dynamic pain relief regimens and the great potential to improve postoperative outcome if such analgesia is used for rehabilitation. To achieve advantageous effects, accelerated multimodal postoperative recovery programs should be developed as a multidisciplinary effort, with integration of postoperative pain management into a postoperative
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2017, Physiotherapy (United Kingdom)Citation Excerpt :Inadequate pain relief may result in reduced chest wall expansion, shallow breathing, ineffective cough, retained secretions, atelectasis and pneumonia [8,12,30,31]. Physiotherapists use interventions such as walking, deep breathing exercises, and coughing, in post cardiac surgery patients to prevent and treat postoperative pulmonary complications [5,10] and to commence early rehabilitation [11]. Milgrom et al. [8] found that in the early post-operative cardiac surgery period, coughing elicited the highest pain, followed by movements such as walking or getting up from a chair; deep breathing exercise and incentive spirometry, with lowest pain occurring when resting in the chair or in the bed.
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2015, Journal of Hand Surgery
Address reprint requests to Henrik Kehlet, MD, PhD, Department of Surgical Gastroenterology, Hvidovre University Hospital, University of Copenhagen, Kettegård Allé 30, 2650 Hvidovre, Denmark
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From the Department of Surgical Gastroenterology, Hvidovre University Hospital, University of Copenhagen, Denmark