Acute, Postoperative, and Periprocedural Pain
Principles
Preemptive analgesia - treating before the painful stimulus - reduces central sensitization. Enhanced recovery pathways pair multimodal, opioid-sparing regimens with regional anesthesia and early mobility. With patient-controlled analgesia, verify drug, concentration, and settings, teach that only the patient presses the button (no proxy dosing), and monitor sedation and respiratory rate. Basal rates are generally avoided in opioid-naive patients. Neuraxial opioids can cause delayed respiratory depression up to 24 hours; monitor per protocol.
Distinguishing expected pain from complication
Expected surgical pain improves steadily and responds to the ordered regimen. Escalating pain, pain out of proportion to the procedure, or pain accompanied by new findings should trigger assessment for compartment syndrome, hematoma, anastomotic leak or perforation, infection, or thromboembolism before any dose increase. Document functional goals - ambulation, coughing, sleep - not just a number.
Procedural and pediatric pain
Use topical anesthetics for needle procedures and allow adequate onset time (about 30–60 minutes for eutectic lidocaine/prilocaine). For infants, sucrose or breastfeeding and facilitated tucking reduce distress. Use comfort positioning, distraction, and honesty about what will be felt; restraint only when necessary and never as a substitute for analgesia.
Traps
Attributing every complaint to "just surgical pain" delays rescue of a complication. Do not give intramuscular injections to children when oral or IV routes are available. Do not forget reassessment after a rescue dose, and do not let a numeric target override a patient who cannot deep breathe.
Rule of thumb: new, severe, or escalating pain that does not fit the expected pattern is a complication workup before it is an opioid dose.