POSTOPERATIVE MANAGEMENT

Look out for the following in recovery:

• Airway obstruction
• Hypoxia
• Haemorrhage: internal, external
• Hypotension, hypertension
• Postoperative pain
• Shivering, hypothermia
• Vomiting, aspiration
• Falling to floor
• Residual narcosis

PAIN MANAGEMENT TECHNIQUES

• Pain is often the patient’s presenting symptom, provides useful clinical information
• Responsibility to use this information to help alleviate the patient’s suffering
• Manage pain wherever the patient is seen (emergency, operating room, ward), anticipate needs for pain management after surgery, discharge
• Do not unnecessarily delay pain treatment; for example, do not transport the patient without analgesia simply so that the next practitioner can appreciate how much pain the patient is experiencing

POSTOPERATIVE PAIN MANAGEMENT

• Effective analgesia is an essential part of postoperative management:
  - "Pain management is our job“
• Prescribe regular analgesia; in practice, “On demand” often means “Not given”
• Important injectable drugs for pain are opiate analgesics
• Non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac (1 mg/kg) and ibuprofen can also be given orally and rectally, as can paracetamol (15 mg/kg)

PAIN MANAGEMENT FOR CHILDREN

• Children suffer from pain as much as adults, but may show it in different ways
• Opiate analgesics should be given cautiously if age is less than 1 year; not recommended for babies less than 3 months
• When opiate analgesia is needed on ward, the most usual is to give intramuscular regimen:
  - Morphine:
  • Age 1 year to adult: 0.1–0.2 mg/kg
  • Age 3 months to 1 year: 0.05–0.1 mg/kg
• Ketamine anaesthesia is widely used, also good for pain control

REVIEW of CORE LEARING OBJECTIVES

• Pre-operative assessment
• Pre-anaesthesia checklist
• Techniques: Local, Spinal, Ketamine
• Anaesthesia in emergency situations
  - Pregnancy
  - Paediatrics
• Monitoring
• Post-operative management
• Pain management