Analgesia in PACU: Indications, Monitoring, Complications

The correct treatment of postoperative pain, in the early period immediately following surgery, is founded on the following four principles: 1- correct diagnosis of the source and magnitude of nociception; 2- understanding of the relationship of ongoing nociception and other components of pain including anxiety, ethnocultural components, meaning, prior experience; 3- treatment by establishment and maintenance of drug level at active sites to achieve and maintain analgesia and anxiolysis as appropriate; 4- continued re-evaluation of the therapy and refinement of the approach. The PACU standard of cure requires a strict accordance between intra and postoperative analgesia. It requires "proactive preoperative plan" that includes: - preoperative patient evaluation; - discussion with a single patient on different treatment options; - patient and family education; - pre-emptive measures as indicated; - intra-operative multimodal analgesia; - a correct triage of analgesia, just after initial evaluation of vital parameters in PACU; - re-evaluation of analgesia plan, if analgesia is inadequate; - a new titration, intravenous or epidural way, in order to achieve a stable VAS < 3; - plan a new analgesia scheme or confirm a preoperative plan; - control of adverse events, related to analgesia plan (gastric bleeding and/or bleeding of the surgical wound site, NSAIDs-induced renal damage, respiratory depression, delayed canalisation, nausea, vomiting, excessive sedation, difficulty in bladder emptying, itchiness); - a transmission of analgesia plan to ward nurses; - a control quality for verify at prefixed times patients satisfaction level, analgesia performed, adverse effects percent, analgesia related, plan variations percent.