Postoperatieve pijnbestrijding: richtlijnen, organisatie en technieken

Postoperative pain is one of the most frequent complications immediately following surgery.

Postoperative pain causes discomfort for the patient and can bring about increased postoperative morbidity. For this reason suppression of postoperative pain is an important part of modern perioperative medicine.

It is appropriate that a chapter entitled 'Postoperative pain' has been included in the Key Performance Indicators employed by the Dutch Health Care Inspectorate.

Two pain measurement tools which are often used are the 'Numerical rating scale' (NRS), and the visual analogue scale (VAS). The nursing profession prefers the NRS because it is quicker and easier to administer.

Powerful synthetic opioids such as fentanyl, sufentanil en remifentanil are mostly used for pain control during the perioperative period. Immediately following the operation these are usually replaced by morphine or piritramide. The Dutch Institute for Healthcare Improvement (CBO) guideline recommends choosing one basic opioid for postoperative pain control within an institution.

It is recommended to use opioids in combination with non-opioids in order to minimize the occurrence of side-effects (balanced analgesia).

Epidural pain control and other regional nerve blocks are very effective in control of postoperative pain.

In a number of cases patient-controlled analgesia (PCA) can be employed, for instance via the intravenous or epidural route.