136 The Journal of Pain Management of Postoperative Pain

Table 2. Suggested Elements of Postoperative Pain Assessment

ELEMENT QUESTIONS USED FOR ASSESSMENT
1. Onset and pattern When did the pain start? How often does it occur? Has its intensity changed?
2. Location Where is the pain? Is it local to the incisional site, referred, or elsewhere?
3. Quality of pain What does the pain feel like?
4. Intensity How severe is the pain? (See Table 1)
5. Aggravating and relieving What makes the pain better or worse?
factors
6. Previous treatment What types of treatment have been effective or ineffective in the past to relieve the pain?
7. Effect How does the pain affect physical function, emotional distress, and sleep?
8. Barriers to pain assessment What factors might affect accuracy or reliability of pain assessments 128 (eg, cultural or language barriers,
cognitive barriers, misconceptions about interventions)?

LOCAL, INTRA-ARTICULAR OR TOPICAL

TYPE OF SURGERY SYSTEMIC PHARMACOLOGIC THERAPY TECHNIQUES* REGIONAL ANESTHETIC TECHNIQUES* NEURAXIAL ANES
Thoracotomy Opioidsz Paravertebral block Epidural with loc
NSAIDsx and/or acetaminophen or without opio
Gabapentin or pregabalinx opioid
i.v. ketamine{
Open laparotomy Opioidsz Local anesthetic at incision Transversus abdominis plane block Epidural with loc
NSAIDsx and/or acetaminophen i.v. lidocaine infusion or without opio
Gabapentin or pregabalinx opioid
i.v. ketamine{
i.v. lidocaine
Total hip replacement Opioidsz Intra-articular local anesthetic and/ Site-specific regional anesthetic Epidural with loc
NSAIDsx and/or acetaminophen or opioid technique with local anesthetic or without opio
Gabapentin or pregabalinx opioid
i.v. ketamine{
Total knee replacement Opioidsz Intra-articular local anesthetic and/ Site-specific regional anesthetic Epidural with loc
NSAIDsx and/or acetaminophen or opioid technique with local anesthetic or without opio
Gabapentin or pregabalinx opioid
i.v. ketamine{
Spinal fusion Opioidsz Local anesthetic at incision Epidural with loc
Acetaminopheny or without opio
Gabapentin or pregabalinx opioid
i.v. ketamine{
Cesarean section Opioidsz Local anesthetic at incision Transversus abdominal plane block Epidural with loc
NSAIDsx and/or acetaminophen or without opio
opioid
CABG Opioidsz
Acetaminophen
Gabapentin or pregabalinx
i.v. ketamine{

Tabel4. Manajen nyeri postoperasi pada pasien dengan terapi opoioid jangka panjang

- Melakukan evaluasi praoperasi untuk menentukan penggunaan opioid praoperasi dan

edukasi penggunaan opioid sebelum pembedahan

- Mengetahui bahwa nyeri postoperasi akan sedikit suli dikontrol