Urgent Management of Sudden Postoperative Pain at Surgical Site
A sudden increase in postoperative pain demands immediate comprehensive evaluation for surgical complications—specifically infection, abscess formation, wound dehiscence, or hematoma—rather than simply escalating analgesics, as this represents a red flag requiring urgent surgical assessment. 1, 2
Immediate Assessment Algorithm
First, rule out life-threatening and limb-threatening complications:
- Examine for infection or abscess by assessing for increased erythema, purulent drainage, warmth, lymphangitic streaking, or fever >38°C (100.4°F) 2
- Evaluate wound integrity by directly inspecting the surgical site for dehiscence or hematoma formation 2
- Assess for compartment syndrome (if applicable to anatomical location) by checking for tense swelling and neurovascular compromise 2
- Document vital signs including temperature, heart rate, and blood pressure, as uncontrolled pain manifests with tachycardia and hypertension 1
Critical Decision Point
If ANY of the following are present, refer immediately to the surgeon or emergency department: 2
- Fever >38°C (100.4°F)
- Purulent drainage or spreading cellulitis
- Pain worsening despite appropriate analgesia
- Neurovascular compromise
- Signs of wound dehiscence
Pain Management ONLY After Excluding Complications
Once surgical complications are ruled out, implement multimodal analgesia: 1
First-Line Therapy (Scheduled, Not PRN):
- Acetaminophen 1 gram every 6-8 hours (cornerstone therapy) 2, 3
- NSAIDs: Ibuprofen 400-600mg every 6-8 hours OR naproxen 500mg twice daily (unless contraindicated) 2, 3
Breakthrough Pain Only:
- Short-acting opioids such as tramadol 50-100mg every 6 hours OR oxycodone 5mg every 4-6 hours 2
- Never use long-acting or modified-release opioid preparations due to increased harm in the postoperative period 2, 4
Common Pitfalls to Avoid
Do not simply increase pain medications without evaluating for complications. A sudden increase in pain, especially when associated with new symptoms, indicates a postoperative complication requiring surgical evaluation, not just more analgesia. 1 This is the most critical error to avoid—treating the symptom while missing a surgical emergency.
Minimize opioid use as opiates can mask evolving complications and worsen outcomes such as ileus. 3 Emergency general surgery patients are at particularly high risk for severe postoperative pain and complications. 1
Monitoring and Reassessment
- Reassess pain and wound status within 24 hours after any treatment changes 2
- Use validated pain scales (NRS, VAS, or VRS) at rest and with movement 1, 3
- Document response to interventions and escalate care if pain persists or worsens 2
The key principle: sudden postoperative pain is a complication until proven otherwise. 1, 2 Postoperative pain must be recognized and treated as soon as possible, but only after excluding surgical emergencies that require immediate intervention rather than analgesics. 1