Management of postsurgical pain in the community

Abstract

Following surgery there is often a need for ongoing pain management after the patient is discharged from hospital. This can be made easier if the patient has an appropriate discussion before leaving hospital about what pain they can expect, and they are given a management plan. Paracetamol and non-steroidal anti-inflammatory drugs are suitable for most patients. Drugs with a short half-life, such as ibuprofen, may need to be taken regularly. Short-acting opioids can have a short-term role, providing guidelines are followed. There is a predictable period of time after surgery when the benefit of an opioid is expected to be maximised before harmful adverse effects will dominate. Gabapentinoids are useful for neuropathic pain, but have a limited role in nociceptive pain. Like opioids, they have a risk of misuse. The surgeon should be consulted if the patient develops new pain or the postoperative pain becomes more severe. Most postsurgical pain will resolve within three months. If not, it is deemed persistent pain that may warrant specialist assessment.