Which
organ systems are affected by postoperative pain?
Multiple organ systems are affected by
improperly treated postoperative pain. After thoracic or upper abdom-inal
procedures, postoperative pain is associated with a decrease in the ability to
breathe deeply and cough, and with reduced lung volumes. These effects
predispose patients to atelectasis and impaired pulmonary toilet, pos-sibly
leading to postoperative fevers. Involuntary splinting of thoracic and
abdominal muscles, reflex muscle spasm, and premature airway closure cause
ventilation-perfusion mismatch, leading to postoperative hypoxemia.
Pain causes stimulation of the sympathetic
nervous system, resulting in release of catecholamines, such as nor-epinephrine
and epinephrine. These circulating amines can result in tachycardia and
peripheral vasoconstriction, increasing the workload on the heart. An increased
incidence of ischemia, dysrhythmias, and hypertension has been shown to occur
in patients whose pain is not adequately controlled.
The sympathetic discharge noted above has an
adverse effect on the gastrointestinal (GI) system, causing an ileus and
decreased GI motility. This effect must be considered with the use of systemic
opioids, which can decrease the peristaltic activity of the GI tract even further.
Pain increases urinary bladder sphincter tone,
with the potential for urinary retention.
The neuroendocrine stress response has been a
topic of recent research. Postoperative pain has been demonstrated to be
associated with a state of increased catabolism and decreased anabolism,
leading to an overall catabolic state with negative nitrogen balance. This is
associated with an increase in oxygen use and metabolism. This stress response
has been associated with decreased wound healing. In addi-tion, activation of
the stress response may be associated with maintenance of a hypercoagulable
state, predisposing the patient to thromboses and embolic events.
Poor postoperative pain control can result in
states of helplessness, depression, and increased anxiety.
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