Recognition of pain in the post-operative period – whether due to patients reporting their pain or clinical appraisal of pain – is imperative for adequate analgesic management. As anesthesia used during the procedure wears off, maintaining an appropriate level of pain relief is essential for patient outcomes and recovery.
Common tools for pain reporting in adult populations include the visual analogue scale (VAS) and the numeric rating scale (NRS), both of which are often used to inform analgesic care.1 The 11-point NRS (NRS-11) and the VAS are highly correlated (Spearmen correlation: 0.94; range: 0.59-0.99) and were found to be equally sensitive to changes in pain intensity.1 They both are useful for the assessment of pain intensity for adults in the acute, post-operative period.2 Additional elements to post-operative pain assessment include a thorough review of pain symptomatology, contributing factors, and confounding variables – including onset and pattern, location, quality, intensity, aggravating and relieving factors, previous treatments and their efficacy, efficacy of current treatments, and barriers to pain assessment (e.g., cultural or linguistic barriers, treatment misconceptions, and cognitive barriers).3,4
Post-operative pain management in adult populations is largely driven by the 2015 joint guidelines proposed by the American Pain Society, American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia.3 Key takeaways from these guidelines include the emphasis of multi-modal strategies (i.e., combinations of non-steroidal anti-inflammatory drugs [NSAIDs], Tylenol, local anesthetic-based regional [i.e., peripheral or neuraxial] techniques, and opioids) in most situations, as well as the initiation of post-operative pain management in the pre-operative period. Multi-modal pain management has been shown to provide superior pain relief and result in decreased opioid requirements when compared with a single medication administered via one technique.5 However, it is important to use individualized approaches to post-operative analgesic management, considering a patient’s medical history, procedure type, and pain reporting.3
The revised faces pain scale (FPS-R) is a validated pain assessment tool for children aged 4 years and older. The FPS-R, which employs six faces as a pain scale, has a strong positive correlation with VAS rating.6 For even younger patients, the Face, Legs, Activity, Cry and Consolability (i.e., FLACC) pain assessment scale may be utilized, as it has been validated for use in children aged 2 months to 7 years.7
Post-operative pain management for children leans toward non-opioid analgesics. Data has demonstrated the efficacy in the use of non-opioid analgesics to reduce opioid use in young patients.8 In 2018, the European Society for Paediatric Anesthesiology (ESPA) Pain Committee published guidelines outlining best practices for
post-operative analgesia in pediatric populations.9 The ESPA Pain Committee takes a tiered approach to systemic post-operative analgesia. These tiers are basic, intermediate, and advanced – corresponding to increasing intensity of analgesics, further stratified by route (e.g., rectal, oral, intravenous) and drug class (e.g., NSAIDs, Tylenol, other).9
In conclusion, post-operative analgesic management is strongly guided by validated pain reporting tools that vary depending on the intended population. Ultimately, practice should be tailored towards the patient, their wishes, and their needs.
References
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