The recommendations for perioperative pain relief in general surgery.

Post-operative pain is caused by intra-operative damage to the tissue/organs; its intensity and range are usually proportional to the extent of surgery. Post-operative pain occurs when intra-operative analgesia stops acting. It is caused by damaged superficial tissues (skin, subcutaneous tissue, mucous membranes), as well as deeper structures (muscles, fascias, ligaments, periosteum). If an injury is large, apart from superficial and deep somatic pain, also a visceral component of post-operative pain appears, resulting from the contraction of smooth muscles, caused by crushing or stretching of visceral structures along with inflammatory changes, pulling or twisting of the mesentery. Post-operative pain is a „self-limiting phenomenon”. It is the most intense on the first and second day after surgery and much smaller on the third or fourth day. Pain is the most irritating in patients after thoracotomy and abdominal surgeries, while the procedures on integuments and limbs are much less painful. The following factors are crucial in patient’s perception of pain: the location of surgery, its extent, a degree of tissue trauma, a direction of skin cutting and perioperative analgesia techniques. Pain relief is a fundamental right of the patient. We know that the proper treatment of postoperative pain (POP) significantly reduces perioperative morbidity, including the number of postoperative complications, the duration and costs of hospitalization, especially in patients at the high risk (ASA III-V), those undergoing extensive surgery and hospitalized at intensive care units. Therefore, relieving acute pain, including post-operative pain must be one of the priority institutional objectives and an integral part of treating a „perioperative disease” covering pain relief, early mobilization and enteral nutrition along with active physiotherapy). In Poland, a team of experts appointed by the Association of Polish Surgeons, Polish Society for the Study of Pain, the Polish Society of Anaesthesiology and Intensive Care, has established the following criteria for proper organizing the system aimed to improve the quality of pain management in the postoperative period: – the assessment of pain intensity in all operated patients, at least 4 times a day, – informing patients before surgery, about the possible methods of postoperative pain management, – recording the measurements of pain and the management in accordance with the recommendations of pain relief, – monitoring possible side effects of the treatment on a special form designed to report adverse drug reactions. Appropriate patient education is a crucial element of pain management in the perioperative period. It involves oral and written information on post-operative pain and its methods of treatment. This information should include the most important data on: – methods of measuring the pain, – methods of pain relief, – the importance of post-operative pain relief for the therapeutic process. Preoperative talk to the patient, his legal guardians or relatives should focus on: – obtaining information on patient’s previous experiences with pain and preferences for analgesic treatment,