Early post-operative pain
As we reassure ourselves as to the patient’s safety, we begin to consider the patient’s pain. Three points need attention: (i) surgical incisional pain will decrease over time, (ii) analgesic effects left over from the anesthetic will wane over time, and (iii) pain counteracts the CNS depressant (respiratory) effects of narcotic analgesics (Fig. 6.1). Thus, pain management in the PACU must seek a balance of three shifting slopes of which we do not know the rate of change. This translates into: watch the patient and titrate drugs to balance adequate analgesia and avoid respir-atory depression. As long as the patient cannot take oral medication, a practical approach for the acute phase of pain management in the PACU can make use of intravenous morphine in 2.0 mg increments for the average adult. It takes about 5 minutes for such a dose to show an effect. Therefore, wait at least 5 minutes before giving the next dose. Many factors influence the patient’s response to such treatment. A patient on chronic narcotic therapy will require more, a frail elderly person less. Titrate! Titrate! Titrate!
After minor surgical procedures, many patients will not require opioids at all, and most can take oral medication. The pharmacology chapter gives drugs and dosages.
There would be no need for a PACU if it were not for the occasional complica-tions that require early recognition and prompt treatment. Here is a quick review of potential problems encountered in the PACU.