Synopsis
Assess and treat acute pain after adult surgery with function-led, multimodal and procedure-specific care while detecting complications and limiting opioid-related harm.
- Assess what pain prevents the patient from doing, its site and trajectory, and whether the pattern fits the operation; a number alone cannot distinguish undertreatment from a complication.
- Use procedure-specific multimodal analgesia where suitable: combine non-opioid medicines, regional techniques and non-pharmacological measures, then reserve immediate-release opioid for defined functional goals.
- Sedation is an early warning of opioid-induced ventilatory impairment; check it with respiratory observations and escalate before profound hypoxaemia develops.
Key red flags
Increasing pain with a tense limb, pain on passive stretch or neurological change requires urgent assessment for compartment syndrome.
New severe chest, abdominal or back pain with instability, bleeding, peritonism or hypoxaemia needs cause-directed emergency assessment rather than repeated opioid boluses.
Rising sedation, reduced respiratory rate, airway obstruction or desaturation in a patient receiving opioids may precede ventilatory arrest.
New motor weakness, sphincter dysfunction or severe spinal pain during epidural analgesia requires urgent review for excessive block or neuraxial compression.
Pain accompanied by fever, wound discharge, crepitus or rapidly spreading erythema raises concern for deep infection or tissue ischaemia.
Pain persisting beyond the expected trajectory, especially with neuropathic features or high opioid use, warrants early specialist review.
Increasing drowsiness, snoring obstruction, slow or shallow breathing and reduced responsiveness require immediate opioid review and airway support.
Sudden escalation, instability, peritonism, tense swelling or pain on passive stretch demands urgent surgical review.
Reasoning priorities
Define pain mechanism, severity, functional limitation and response to treatment.
A falling number without improved breathing or movement may not represent success; new focal findings or deterioration redirects assessment toward a complication.
Worked reasoning
A stable adult reports incisional pain that prevents deep breathing and mobilisation after major abdominal surgery.
- Examine the patient and wound, review observations and operative events, confirm that the pattern is expected, and set functional goals for cough, deep breathing and mobilisation.
- Give regular non-opioid analgesia where suitable, check any regional technique and add a small titrated immediate-release opioid dose if function remains limited.
- Reassess function, pain, nausea, sedation and ventilation after treatment; involve the acute pain service if goals remain unmet or adverse effects limit titration.
- Reduce treatment as recovery progresses and prepare a discharge plan that names each medicine, duration, taper and safety advice.