Postoperative pain is a common consequence of surgical procedures, affecting patients’ comfort, recovery, and overall satisfaction. The intensity and duration of postoperative pain can vary based on factors such as the extent of tissue damage, surgical technique, and individual patient characteristics. Managing pain effectively after surgery is essential to minimize discomfort, facilitate early mobilization, and reduce the risk of complications. Inadequate pain control has been associated with higher incidences of postoperative nausea and vomiting, increased cardiac pulmonary stress, delayed wound healing, and increasing length of hospital stay [3]. By understanding the variations in postoperative pain levels by surgery type, healthcare professionals can improve pain management strategies and optimize patient care, and patients can better understand what to expect.
Orthopedic surgery is considered to be a broad type of surgery that often carries high levels of postoperative pain. Studies evaluating postoperative pain levels consistently reported moderate-to-severe pain during the early postoperative period. In a recent study, the multimodal analgesia model (MMA) has been described as an important clinical tool for balancing pain control but mitigating risks of opioid usage in the realm of orthopedic surgeries [1]. This involves usage of various analgesic agents including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Further, MMA can be used to create individualized pain regimens based on the severity of the injury and surgery type [2]. This was described by Hsu et al. who broke up the regimens based on major musculoskeletal surgery, minor musculoskeletal surgery, and non-operative or closed treatment [2].
For abdominal surgeries, such as appendectomies and cholecystectomies, studies reported varying pain levels depending on the extent of the surgery and the surgical approach. Studies have demonstrated that patients undergoing laparoscopic cholecystectomy experienced less pain, better cosmetic outcomes, faster healing, and earlier mobilization compared to those undergoing open cholecystectomy [4]. The laparoscopic approach quickly became the gold standard for cholecystectomies in developed countries. Similarly to the MMA model, the Enhanced Recovery After Surgery (ERAS) program was designed to optimize perioperative care and postoperative outcomes. Together with a perioperative management program, PROSPECT, guidelines were established to improve postoperative pain, length of hospital stay, complications, as well as adverse effects related to opioid usage [3,5].
Studies examining postoperative pain in gynecological surgeries, including hysterectomies and ovarian cystectomies, also demonstrated that minimally invasive techniques resulted in reduced postoperative pain compared to open procedures [6]. A systematic review of PROSPECT recommendations following laparoscopic hysterectomies found that a sufficient baseline pain regimen should consist of acetaminophen, an NSAID, dexamethasone, and an opioid only as a rescue analgesic [6].
The level of postoperative pain experienced by patients often varies depending on the type of surgery. Factors such as surgical approach, invasiveness, and patient characteristics can influence pain intensity. Healthcare professionals should consider these variations when implementing pain management protocols. Tailored pain management strategies, including the multimodal analgesia model, ERAS and PROSPECT guidelines, and minimally invasive procedures, have shown promising results in mitigating postoperative pain across differing surgical interventions. Further research is warranted to explore the efficacy of novel pain management techniques.
References
Sampognaro G, Harrell R. Multimodal Postoperative Pain Control After Orthopaedic Surgery. [Updated 2023 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.
Hsu JR, Mir H, Wally MK, Seymour RB., Orthopaedic Trauma Association Musculoskeletal Pain Task Force. Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury. J Orthop Trauma. 2019 May;33(5):e158-e182.
Chen Q, Chen E, Qian X. A Narrative Review on Perioperative Pain Management Strategies in Enhanced Recovery Pathways-The Past, Present and Future. J Clin Med. 2021 Jun 10;10(12):2568.
Johansson M, Thune A, Nelvin L, et al. Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis. Br J Surg 2005;92:44–9.
Lee B., Schug S.A., Joshi G.P., Kehlet H., Group P.W. Procedure-Specific Pain Management (PROSPECT)—An update. Best Pract. Res. Clin. Anaesthesiol. 2018;32:101–111.
Lirk P, Thiry J, Bonnet M for the PROSPECT Working Group, et al. Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations. Regional Anesthesia & Pain Medicine 2019;44:425-436.