Which factors in this patient’s history may impact on postoperative pain management?

Which factors in this patient’s history may impact on postoperative pain management?

A patient’s preoperative emotional and psychiatric state can greatly influence his or her response to pain in the postoperative period. Fear, uncertainty, and helplessness are factors which may influence a patient’s anxiety level. In addition, psychiatric states, such as depression, can increase a patient’s postoperative pain. This patient’s past experience with improperly treated postoperative pain, as well as his knowledge of his recent diagnosis of cancer, may heighten his anxiety, and thus make his postoperative pain more difficult to control. In addition, his use of an opioid anal-gesic (oxycodone) for a few months prior to surgery may make him mildly tolerant to the effects of the opioids administered in the postoperative period. Tolerance means that a higher dose of medication will be needed to obtain the desired clinical effect.

In this patient, it would be wise to continue the use of a benzodiazepine in the postoperative period to avoid with-drawal symptoms. In addition, it would be prudent to give him the equivalent dose of his long-acting morphine throughout the postoperative period, as well as a higher dose of systemic opioids, thus taking into consideration the toler-ance which he has developed. If possible, the use of epidural opioids and local anesthetics, in addition to non-opioid analgesics, such as ketorolac, a parenteral nonsteroidal anti-inflammatory drug (NSAID), may provide better analgesia.