Common postoperative problems

Postoperative complications are common, despite good pre-op assessment, surgical technique and perioperative management.

Complications can be minimised by regular and close postoperative patient observation. Managing complications effectively requires quick diagnosis and treatment before the complication gets out of hand.

Postoperative pain

• Pain from surgical wounds should subside over the first few days, and should be controlled by planned analgesia. Some types of wounds (e.g. vertical abdominal incisions) are more painful than others.
• Postoperative pain can be reduced by:
  
  • Preoperative counselling - letting the patient know in advance what to expect after the operation in terms of wounds, IV lines, catheters, extent of pain, plans for pain relief and degree of mobility.
    
  • Peroperative measures - preemptive analgesia to ensure pain does not become established after operation e.g. long acting analgesics, local anaesthetic infiltration into the sound edges, regional nerve blocks, morphine epidurals etc.
    
  • Postoperative analgesia - better to prevent pain than to react to established pain!
    
  
  
• Patients vary in their tolerance for pain and need for analgesics. Anxiety, exhaustion and sleep deprivation all reduce pain tolerance.
  
• If the pain is not controlled by what seems to be a normal dose and frequency of analgesia, complications should be suspected.
  
  • Review dose in relation to expected severity of pain and the weight of the patient.
    
  • Consider local postoperative complications such as haematoma -> wound pain, bleeding into fascial compartment -> compartment syndrome, wound infection -> pain increasing after 48 hours.
    
  
  

Pyrexia

• Infection is not the only cause of postoperative pyrexia, however it should always be considered and investigated as a cause.
• Common postoperative infections include superficial and deep wound infections, chest infections (pneumonia), UTIs and IV cannula site infections.
• Infection is not likely to be a cause in fever developing within 2 hours of surgery - it normally takes longer to develop.
  
• Common non-infective causes of pyrexia include transfusion reactions, drug reactions, wound haematomas, DVT and pulmonary emboli.

Tachycardia

Tachycardia can be benign or malignant.
Benign causes of postoperative tachycardia:

• pain
• anxiety

Malignant causes of postoperative tachycardia:

• infection
• circulatory disturbances
• thyrotoxicosis
• Mild tachycardia can be a sign of incipient hypovolaemic shock resulting from haemorrgahe or dehgydration.
• Cardiac failure.
• AF or flutter.
• Anastomotic leakage - after bowel surgery.