Postoperative Pain Management

Postoperative pain management starts with systematic assessment using validated tools — the numeric rating scale (0-10) for verbal adults, the Wong-Baker FACES scale for children or cognitively impaired clients, and behavioral cues (guarding, grimacing, restlessness) for nonverbal clients. The client's self-report is the gold standard; physiological signs like tachycardia and diaphoresis are unreliable because the body adapts. Multimodal analgesia is the current standard: combining opioids with non-opioid adjuncts (acetaminophen, NSAIDs, nerve blocks) reduces total opioid consumption and side effects. Around-the-clock dosing controls pain more effectively than PRN-only regimens in the first 24-48 hours. Patient-controlled analgesia (PCA) gives the client autonomy — only the client presses the button, never a family member or nurse, because the built-in sedation safeguard requires consciousness. Before administering opioids, you assess respiratory rate (hold if <12), sedation level (Pasero Opioid-Induced Sedation Scale), and pain intensity. After administration, reassess within 30 minutes for IV and 60 minutes for oral routes. Nonpharmacological interventions — repositioning, ice, splinting the incision, guided imagery — complement medications and should be documented as part of the plan.