Assessing "Pain" Under GA
Sep 12, 2024
Ever wondered if your patient can feel “pain” when they are under anaesthetic? 🤔
Surely they don’t feel anything, right?
Assessing “pain” in an unconscious patient can be tricky business 🧠, but there are a few tell-tale signs to look for 👀. In order to see them, it's important to understand what pain is, and how it may present in an unconscious patient.
What is “pain”?
First - let’s have a look at what, exactly, “pain” is. The International Association for the Study of Pain (IASP, 2020) defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” ⚡
During surgery, we know that there is ACTUAL tissue damage 🩹 (AKA noxious stimuli) occurring. Within the Nervous System are nociceptors, which respond to this noxious stimuli and transmit warning signals to the brain 🧠 - known as nociception. Once these signals are received and processed by the brain, and have meaning attached to them (this is the sensory and emotional experience part!) a pain response is elicited - which becomes tricky when someone is unconscious! 😴
Analgesia vs Hypnosis:
So does an unconscious patient experience pain? 💭
Hypnosis is used to render a patient into a state of controlled unconsciousness. However, the presence of noxious stimuli - such as a scalpel or diathermy - will still have nociceptors firing off like crazy ⚡ to the brain 🧠, which is why another key component to the triad of Anaesthesia is Analgesia. Analgesia, in its various forms and modes of action, will help to dull or block these nociceptive signals as they travel up and down the pain pathways in the body. 🛡️
So how can you spot “pain”?
Because your patient is unconscious, you will not see or hear the usual verbal and behavioural cues associated with pain 😶. Instead, you will need to look for the physiological signs. Noxious stimuli will elicit a sympathetic response, with an increase in heart rate ❤️, blood pressure 📈, and respiratory rate 🫁 being the tell-tale signs that your patient needs some analgesia! 💊
Good postoperative pain management starts preoperatively, so adequately managing a patient’s “pain” under anaesthesia will make a drastic difference to their recovery. 💪
Build knowledge ✅
Improve safety ✅
Ref:
ANZCA (2020). Acute Pain Management: Scientific Evidence. 5th edition https://www.anzca.edu.au/resources/college-publications/acute-pain-management/apmse5.pdf
IASP (2020) Revised Definition of Pain. https://www.iasp-pain.org/publications/iasp-news/iasp-announces-revised-definition-of-pain/
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