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Post-Operative Pain Management
Post-Operative Pain Management is the specialist care provided by the acute pain team to ensure your pain after surgery is effectively controlled - using a multimodal combination of analgesic techniques tailored to your surgery and physiology to minimise pain, promote early recovery, and reduce opioid side effects.
Overview
Post-operative pain management is coordinated by the specialist acute pain service - anaesthesiologists and dedicated acute pain nurses - who design and implement an individualised multimodal analgesic plan combining different classes of analgesics that work synergistically to control pain more effectively than any single agent alone. Paracetamol, NSAIDs, nerve blocks, epidurals, opioids, and adjuvants including gabapentinoids and ketamine are combined strategically to maximise pain control while minimising opioid consumption and its associated side effects of nausea, constipation, sedation, and respiratory depression. Effective post-operative pain management is not a luxury - it directly reduces complications, shortens hospital stay, enables physiotherapy, and improves surgical outcomes.
Types of Post-Operative Analgesia
The analgesic techniques used are selected based on the surgery type, expected pain severity, and patient factors.
- Patient-Controlled Analgesia (PCA - patient-activated IV opioid with safety lockout)
- Epidural Infusion (continuous local anaesthetic and opioid epidural for major thoracic and abdominal surgery)
- Peripheral Nerve Block Catheter (continuous perineural local anaesthetic infusion for limb surgery)
- Multimodal Oral Analgesia (scheduled paracetamol, NSAID, and weak opioid with rescue)
- Wound Infiltration Catheter (continuous local anaesthetic to surgical wound)
- Ketamine Infusion (sub-anaesthetic dose for opioid-tolerant patients and complex pain)
Risk Factors for Difficult Post-Operative Pain Control
Identifying these risk factors before surgery allows the acute pain team to plan more intensive pain management strategies.
- Chronic pre-operative opioid use or opioid dependence
- Pre-existing chronic pain conditions - fibromyalgia, neuropathic pain, complex regional pain syndrome
- Young age and high pre-operative anxiety - associated with higher post-operative pain scores
- Catastrophising pain behaviour as assessed pre-operatively
- History of substance use disorder requiring opioid-sparing strategies
- Previous inadequate post-operative pain control requiring revision of analgesic approach
Indications for Specialist Acute Pain Service Involvement
All post-operative patients benefit from good pain control, but specialist acute pain team involvement is particularly important for these presentations.
- Major thoracic, abdominal, or orthopaedic surgery with expected severe post-operative pain
- Opioid-tolerant or opioid-dependent patients requiring higher analgesic doses
- Patients with chronic pain conditions requiring modification of standard protocols
- Complex regional anaesthesia including epidural and perineural catheter management
- Paediatric post-operative pain requiring age-specific dosing and assessment tools
- Patients experiencing inadequate pain control on standard ward analgesic protocols
- Post-operative patients requiring ventilatory support in ICU settings
- Palliative care patients with pain crises requiring rapid dose titration
Key Benefits
Discover the advantages of choosing our post-operative pain management services.
Effective pain control enables earlier mobilisation reducing DVT and pneumonia risk
Reduced opioid requirements from multimodal analgesia reduce nausea and constipation
Superior pain control allows earlier commencement and better engagement with physiotherapy
Proactive management prevents central sensitisation from developing with uncontrolled acute pain
Clear discharge analgesic plan prevents pain crises in the first days at home after surgery
Clinical Features
The technology, techniques and clinical approach behind our post-operative pain management.
Pre-operative pain assessment identifies high-risk patients for proactive analgesic planning
Multimodal approach combines different drug classes for additive analgesia with reduced side effects
Acute pain service daily ward rounds prevent inadequate pain from persisting unaddressed
Numerical pain scoring at every nursing assessment creates an objective pain management record
PCA device safety lockout prevents patient-administered opioid overdose
Preparation Instructions
Report pain scores honestly to the nursing and pain team - good pain control is a clinical priority, not a sign of weakness. Take discharged oral analgesics at the prescribed times rather than waiting until pain becomes severe. Gradually reduce opioid analgesics as directed - never stop suddenly if you have been taking them for more than 2 weeks. Contact the pain team or your GP if post-discharge pain is not controlled by prescribed medications or if you have concerns about analgesic side effects.
The Procedure
Step-by-step guide to what you can expect during your post-operative pain management procedure.
Pre-Operative Pain Assessment
Your anaesthesiologist assesses pre-operative pain levels current analgesic use and risk factors for difficult post-operative pain control -- designing a multimodal analgesic plan before surgery rather than reactively managing pain afterwards.
Intraoperative Analgesic Foundation
Regional nerve blocks wound infiltration IV paracetamol NSAIDs and low-dose ketamine are administered during surgery to establish analgesic protection before you wake -- significantly reducing immediate post-operative pain.
Recovery Room Pain Management
Pain is assessed using a numerical rating scale from the moment you wake. IV analgesics are titrated by the recovery nurse to achieve a pain score of 3 or less before transfer to the ward.
Ward Multimodal Analgesia
Scheduled oral analgesics -- paracetamol NSAID and opioid as required -- are prescribed at regular intervals maintaining consistent analgesic blood levels and preventing breakthrough pain between doses.
Acute Pain Service Daily Review
The acute pain team visits daily to assess pain control review the analgesic plan check for side effects and adjust the prescription. PCA pumps are managed and step-down plans developed as pain resolves.
Discharge Analgesic Planning
Before discharge you receive an appropriate oral analgesic prescription clear instructions on taking it correctly a step-down plan and guidance on which symptoms should prompt contacting medical services.
What to Expect
Your pain is assessed regularly using a numerical pain score and the acute pain team visits daily on rounds to review your analgesic plan. You will receive scheduled analgesics at regular intervals and rescue doses for breakthrough pain. The PCA device allows you to give yourself small safe doses of opioid when needed with an automatic lockout preventing overdose. Your pain level, side effects, and satisfaction with pain control are all actively monitored.
Frequently Asked Questions
Common questions about post-operative pain management.
Related Services
Explore other services in our Anaesthesiology department.
General Anaesthesia
Spinal Anaesthesia
Epidural Anaesthesia
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