Page 80 - HA Convention 2015

Masterclasses

MC3.1 Peri-operative Pain Management 16:15 Convention Hall A

Monday, 18 May Peri-operative Pain Management — a Multidisciplinary Team-based Approach
Wong SHS
Department of Anaesthesiology and Operating Theatre Services, Queen Elizabeth Hospital, Hong Kong

The identification of “chronic post-surgical pain” as an independent disease entity has led to a more proactive approach in
the management of pain after surgery. In addition to the traditional way of “on-demand” analgesics given either by nurses
or via patient-controlled means, pre-emptive and preventive measures are employed including the use of multi-modal
analgesics and nerve block techniques, as well as anti-neuropathic agents which are originally developed for treatment of
chronic pain conditions.

The growing trend of minimally-invasive surgery has enabled patients to have earlier ambulation and thus shorter hospital
stay. This has put more demand on the control of postoperative pain and led to the integration of pain management with
postoperative rehabilitation. Specific pain management protocols tailor-made to different surgical procedures have been
developed. This has transformed post-operative pain management from a “doctor-prescription” approach to a “multi-
disciplinary team-based” approach.

This presentation will highlight some of the barriers in the existing peri-operative pain management service and explore
options for way forward.

MC3.2 Peri-operative Pain Management 16:15 Convention Hall A

HOSPITAL AUTHORITY CONVENTION 2015 Multi-modal Peri-operative Pain Management – an Evidence-based Physiotherapy Perspective
Leung AKP
Physiotherapy Department, Queen Elizabeth Hospital, Hong Kong

Pain is complex and multi-faceted. As an undesirable sequel of major surgery, it intensifies endocrine metabolic responses,
autonomic reflexes, nausea, muscle spasm; and thereby delays restoration of function. To facilitate recovery and reduce
morbidity, optimal peri-operative pain management is of utmost importance in holistic patient care. To provide quality patient
care, we should address patient’s physical, psychological and social needs in the peri-operative pain management model.

Pain is unpleasant. Understanding its mechanism is mandatory to enhance pain management. Besides pharmacological
options, non-pharmacological methods, which include various physiotherapy techniques, are alternatives in peri-operative
pain management. Literatures suggested that uni-modal analgesia is not sufficient, whereas the use of additive and
synergistic effects of multiple modes can provide optimal pain management.

Comprehensive physiotherapy in peri-operative period is emerging as an important component in the multi-modal of patient
care process. Physiotherapists provide pre-operative education which can relieve patient’s anxiety and stress, and enhance
post-operative recovery. Pain-relieving modalities, such as transcutaneous electric nerve stimulation (TENS), acupuncture,
heat and cryotherapy, relaxation, are frequently adopted by physiotherapists in peri-operative pain management. Moreover,
physiotherapists teach proper wound support techniques and provide modalities on promotion of wound healing. Early
mobilisation with supervision by physiotherapists can facilitate patient recovery and reduce morbidity. Fast-tracked
rehabilitation which involves multidisciplinary collaboration between patient, surgeon, anaesthetist, physiotherapist and
nurse offers speedy and effective rehabilitation according to patients’ needs.

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