Postoperative pain is one of the biggest concerns for patients with gastric cancer. How much does it really hurt after surgery? What should I do if it hurts? Will pain medication have adverse effects? Will they even become addictive? Let’s talk more about post-operative pain with these questions in mind.
How much pain is there after surgery?
The human body varies in its sensitivity and tolerance to pain, and each person has a different pain threshold (i.e., the minimal degree of pain felt), which is mainly influenced by various factors such as age, gender, physiology, and psychological state. Therefore, it is not possible to generalize how much pain there is after gastric cancer surgery.
The commonly used pain assessment methods fall into three categories: self-assessment, behavioral assessment, and measurement of physiological changes, with visual analog scoring (VAS) being the most used in the self-assessment method. The physician will give the patient a ruler with a number from 0 to 10, with 0 being a state of no pain and 10 being a state of extreme pain. The patient pulls the ruler to different numbers according to his or her pain, and the physician makes a general assessment of the patient’s pain based on the pain score.
The pain tends to be mild in the hours after surgery because the anesthesiologist will give a dose of long-acting analgesics near the end of the procedure, both to ensure that the patient wakes up and to reduce painful discomfort after waking up. However, after 6 to 8 hours postoperatively, the patient may experience particularly severe pain. In general, the pain of open surgery is mostly moderate to severe, with a score of about 6 to 8 or even 10, while the pain is milder after laparoscopic surgery.
What are the effects of pain?
Many people have the understanding that postoperative pain is something that can be tolerated, believing that enduring it will not harm the body. In fact, it is quite the opposite. Postoperative pain is different from normal physiological pain in that too much pain can cause abnormal autonomic activity, manifested by increased blood pressure, cardiac arrhythmia, shallow and rapid breathing, nausea, and vomiting. At the same time, due to pain, patients are often reluctant to eat, move off the floor, cough and cough up phlegm after surgery, which, combined with depression, may affect incision healing, slow recovery, and even postoperative pneumonia.
What are the benefits of analgesia?
The most obvious thing is that analgesia can reduce the level of pain after surgery. With less pain, patients naturally feel better and have a better quality of life.
Secondly, the reduction in pain also allows patients to get out of bed early, which helps with postoperative gastrointestinal function and reduces the incidence of deep vein thrombosis due to prolonged bed rest.
Lastly, because of the reduction in pain, the patient was able to cough and cough hard, which reduced the incidence of postoperative atelectasis and pneumonia.
What are the commonly used analgesic drugs?
Commonly used analgesic medications include the following:
- Opioids, such as morphine (Morphine) and fentanyl (Fentanyl), are the most powerful and commonly used pain medications after gastric cancer surgery;
- Anti-inflammatory and analgesic drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, etc., often used as a supplement to opioids;
- Local anesthetics, including bupivacaine, levobupivacaine, ropivacaine, and chloroprocaine. By injecting these local anesthetics into the spinal canal in combination with opioids, physicians can enhance the analgesic effect and prolong the duration of analgesia
Commonly administered analgesics include subcutaneous, intramuscular, intravenous, patient-controlled analgesia (PCA, in which the provider pre-sets the dose of the drug and the patient controls its administration based on pain), and over-the-top analgesia (the preventive application of analgesics before the onset of pain). Physicians generally choose to combine multiple drugs in multiple routes in a superimposed, synergistic manner to achieve satisfactory analgesia while reducing dose and side effects.
What are the side effects of analgesics?
Post-operative analgesia is also associated with side effects.
Postoperative analgesia has some side effects, depending on the analgesic drug used. The common side effects include nausea, vomiting, pruritus, abnormal sensation, dyskinesia, urinary retention, sedation, respiratory depression, and circulatory depression. However, the vast majority of patients are still very safe with short-term use of analgesic medications within the safe dose range.
Patients may be concerned that analgesic use may lead to drug dependence or even addiction. The chances of this happening clinically are almost nil! The analgesics currently used do not cause a sudden rise and fall in the concentration of the drug in the blood, and thus do not produce the euphoria of morphine injections and are not addictive. Also, doctors often use morphine-based drugs in conjunction with common antipyretics, which also reduce the dose of morphine-based drugs.
Analgesia, how to do it regularly?
Multimodal analgesia is the most common form of analgesia after gastric cancer surgery, such as acetaminophen + NSAID + local application of anesthetics at the incision and NSAID in combination with opioids, which can mostly achieve good analgesia.
The duration of postoperative analgesia varies from person to person because people have different levels of pain tolerance, and physicians will treat analgesia in different ways depending on the level of pain. In general, the pain level decreases significantly after 2 to 3 days postoperatively, at which point the doctor usually discontinues the analgesic medication to avoid the side effects of prolonged analgesic use.
Postoperative pain is inevitable after gastric cancer surgery, and it is only reasonable to treat the relationship between postoperative pain and pain management and to seek standardized treatment to resolve the pain. It is hoped that patients will receive a reasonable view of postoperative analgesia with the help of their doctors to better survive the recovery period after gastric cancer surgery. (Contributed by Jun Yan Zhang, Department of Gastrointestinal Oncology, The First Hospital of China Medical University)