Perioperative Pain Assessment
Feb 27, 2025
On a Scale of 0 to 10…. π©Ί
Pain is a unique and subjective experience π§ , thus making it extremely difficult to measure in an objective manner. Acute pain assessment in the perioperative environment happens on a daily basis βοΈ, utilising a variety of different assessment methods π and tools π οΈ in order to provide a successful pain management plan π. Here are some of the key factors for a thorough perioperative pain assessment:
Pre op assessment:
π©ΊDoes the patient have a history of chronic pain?
πIf yes, establish the nature and location of the pain
π΄ What (if any) is their baseline level of pain?
π What (if any) is their analgesia regime, and have they had their usual pain medications?
π¦ Has the patient had multiple surgeries? These patients are at a higher risk of developing chronic or prolonged post-surgical pain β οΈ, particularly if the surgeries are performed on the same area, e.g., multiple abdominal procedures.
Intra-op assessment:
Under general anaesthesia ποΈ, pain assessment is guided by physiological response to surgical stimuli π¬. Close monitoring of vital signs, in particular:
β€οΈ Heart rate
π Blood pressure
π¬οΈ Respiratory rate
This data will help to guide analgesia requirements throughout the procedure π οΈ.
Post-op assessment:
Post-operative pain assessment in the recovery room can be challenging to perform π and can change rapidly in a short period of time. The key to a thorough pain assessment is to account for information received from the pre and intra-op assessments π, then collect post-op information using a variety of different assessment tools π§°:
Numeric rating scale (NRS):
We all know this one π - “using a scale of 0-10, how would you rate your pain? 0 being nothing, ten being the worst pain you have ever experienced.”
This tool is useful in determining the intensity of pain π₯, and also provides an objective scale to determine the effectiveness of analgesia that has been administered π.
Functional Assessment Score (FAS):
The FAS provides an indication of limitations to a patient’s function caused by pain as observed by the clinician π¨βοΈ. Functional activity expectations need to be tailored to suit the patient’s condition π, and in the setting of the recovery room, this would generally be based on a patient’s ability to deep breath and cough π€§, or to shuffle themselves comfortably/sit up for limb surgeries π¦΅.
Talk to your patient!
Gather descriptive information from your patient π£οΈ, such as what the pain feels like (e.g. burning π₯, shooting π§¨, throbbing β€οΈπ©Ή), where the pain is located π, its duration β° and triggers β οΈ, and so on. This information can help to detect any potential abnormalities or concerns π:
π¦΄For example; a wrist ORIF patient that feels a tight, pressure-type pain under their cast may need a surgical review π₯ - imagine if you had just treated their numerical rating and not questioned the type of pain!!
π£A patient may be in distress, however, the pain is mainly associated with their chronic lower back pain π₯ (from lying flat on the operating table for hours) and they are not really concerned with the surgical pain π€.
For patients who are culturally and linguistically diverse π, or for those with cognitive impairment π§ , other behavioural tools should be used to assess pain, such as the FACES scale π·, or the PainAD scale.
Remember, pain is an extremely complex and highly unique experience π - there is no such thing as a “non-painful” procedure β, and everyone experiences things differently π€·βοΈ. You should never discount a patient’s pain π«, and everyone has the right to receive high-quality pain management π.
Build Knowledgeβ
Improve Safetyβ
References:
ACSQHC (2024) Quality statement 2 - Acute pain assessment
Adeboye, A., Hart, R., Senapathi, S. H., Ali, N., Holman, L., & Thomas, H. W. (2021). Assessment of Functional Pain Score by Comparing to Traditional Pain Scores. Cureus, 13(8), e16847. https://doi.org/10.7759/cureus.16847
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