What is the recommended treatment plan after surgery?

Recommended Treatment Plan After Surgery

The recommended post-operative treatment plan should include early recognition and treatment of pain, regular pain assessment using validated scales, multimodal analgesia, early mobilization, and appropriate follow-up care to optimize recovery and reduce complications. 1

Pain Management

Assessment and Monitoring

• Pain must be recognized and treated as soon as possible using validated pain scales to assess pain both at rest and during movement 1
• Regular pain assessment should be incorporated into treatment planning and ongoing evaluation to adjust analgesic regimens for optimal effect 1
• Special attention should be given to emergency surgery patients who may experience more severe postoperative pain 1

Multimodal Analgesia

• Implement a multimodal analgesic approach combining different medication classes to maximize pain relief while minimizing side effects 1, 2
• First-line medications should include:
  • Scheduled acetaminophen (if no contraindications) 3, 4
  • NSAIDs such as ibuprofen (if no contraindications like recent MI, heart failure, renal dysfunction, or high bleeding risk) 3, 4
  • Use opioids sparingly as rescue medication only when other methods are insufficient 3, 4
• Consider preemptive analgesia to reduce postoperative opioid consumption 1
• Regional anesthetic techniques (nerve blocks, wound infiltration) should be utilized when appropriate as they are among the most effective methods for managing postoperative pain 2, 5

Special Considerations

• Adjust pain management based on patient history, comorbidities, ongoing chronic therapy, and potential risk for substance abuse 1
• Monitor for and promptly address side effects of analgesics, particularly opioid-related adverse effects 4, 2
• For patients with prolonged pain issues, consider referral to specialized pain management services 6

Early Mobilization and Activity

• Patients should be out of bed for at least 2 hours on the day of surgery and 6 hours per day thereafter until discharge 1, 3
• Early mobilization helps prevent complications such as thromboembolism, insulin resistance, muscle loss, and pulmonary depression 1, 3
• Nursing care should encourage independence and facilitate mobilization 1

Nutrition and Hydration

• Oral fluids can be started as soon as the patient is lucid after surgery 3
• Solid foods should be introduced within 4 hours postoperatively if tolerated 3
• In addition to normal food intake, oral nutritional supplements should be offered to maintain adequate protein and energy intake 1
• Maintain adequate hydration (≥1.5 L/day) to help prevent constipation 3, 7

Venous Thromboembolism (VTE) Prevention

• Continue VTE risk assessment throughout the hospital stay 1
• Implement both mechanical and pharmacological prophylaxis for high-risk patients 1
• For very high-risk patients (including many emergency laparotomy patients), combine pharmacological with mechanical prophylaxis 1
• Consider extended prophylaxis (4 weeks) for high-risk patients, such as those with malignancy 1

Prevention and Management of Complications

Ileus Prevention and Management

• Implement opioid-sparing analgesia strategies to reduce risk of postoperative ileus 7
• Consider chewing gum to help stimulate bowel function 7
• Avoid routine use of nasogastric tubes as they may prolong ileus 7
• Monitor for return of bowel function, including passage of flatus and bowel sounds 7

Delirium Prevention

• Patients over 65 years should receive regular postoperative delirium screening 1
• Manage at-risk patients with non-pharmaceutical interventions such as regular orientation, sleep hygiene approaches, and cognitive stimulation 1
• Minimize medication triggers for delirium 1

Patient Education and Discharge Planning

• Provide adequate education for the patient and family about the surgical treatment, pain management options, and goals 1
• Explain medication choices, properties, effects, and potential side effects 1
• Schedule appropriate follow-up appointments to assess healing and recovery 3
• Provide clear instructions on activity restrictions and when to resume normal activities 3
• Ensure patients know when to seek medical attention for concerning symptoms such as fever, increasing pain, or signs of infection 3

Post-Discharge Care

• Provide clear written and verbal instructions about medication management after discharge 1, 8
• Ensure appropriate transition to outpatient care with adequate pain management plans 8
• For patients with complex pain issues, consider referral to specialized outpatient pain services 6

Special Considerations for Specific Surgeries

• For breast cancer surgery, patients should be actively involved in all management decisions and should have access to the full range of reproductive care options 1
• After laparoscopic procedures, consider local anesthetic injections at port sites to decrease abdominal wall pain 5
• Following thoracic surgery or mastectomy, be vigilant about pain management as these procedures have higher rates of persistent postoperative pain 2