Description
Opioids have long been used in general anesthesia to effectively manage pain. However, data suggests that using opioids during surgery may result in postoperative hyperalgesia, which can lead to chronic postsurgical pain (CPSP) and long-term opioid dependence. Indeed, opioid abuse has become a worldwide concern, with an estimated 40.5 million opioid dependent persons in 2017. Opioid-free anesthesia may thus be an appropriate option. A short time of opioid exposure has been demonstrated to cause epigenetic alterations and a pro-inflammatory state, resulting in nociceptive hypersensitivity. Opioids provided during tissue injury (e.g., surgery) may cause a paradoxical increase in acute postoperative pain and opioid-induced hyperalgesia (OIH), both of which contribute to the development of CPSP.
Summary Listen
- Rehabilitation, as defined by the WHO, aims to optimize function and restore disability in individuals with health conditions by considering their interaction with the environment. The goal is not necessarily to return the patient to their pre-existing state, but to enable them to perform daily activities and achieve functional optimization, making them as independent as possible.
- Post-operative rehabilitation is a medical program designed to help patients regain function after surgery. This includes regaining strength and mobility, improving circulation and breathing, reducing pain, regaining confidence, and returning to daily activities. While recovery timelines vary, studies show rehabilitation reduces hospital stays.
- The goals of post-operative rehabilitation can be divided into short-term and long-term objectives. Short-term goals focus on pain and swelling reduction during hospitalization. Long-term goals aim for lifelong independence, management of post-surgical complications, and improved quality of life. Benefits include effective pain management, enhanced return to daily activities, muscle strengthening, improved posture, independence, and prevention of chest complications.
- The rehabilitation process is often divided into pre-operative and post-operative phases. The post-operative phase is further divided into acute, sub-acute, and post-acute phases. The acute phase focuses on pain management and complication prevention. The sub-acute phase can occur during hospitalization or post-discharge. The post-acute phase focuses on advanced strengthening and return to daily activities.
- Effective rehabilitation requires a multi-disciplinary team including the patient, family, physicians, physiotherapists, occupational therapists, speech therapists, prosthetics/orthotics specialists, and dieticians. It's crucial to assess the patient and guide them through the process, setting realistic goals based on their individual needs and surgical intervention.
- Orthopedic surgeries require personalized rehabilitation plans that consider the type of surgery and individual patient factors. The initial phase aims to prevent complications, control pain and swelling, regain range of motion, and re-establish functional mobility. Subsequent phases focus on increasing strength and endurance, improving balance, and returning to daily activities. Discharge counseling and education are crucial for continued progress.
- Cardiac rehabilitation involves an individualized treatment plan addressing physical activity, nutrition, stress management, and other health-related areas. Objectives include preventing post-operative complications, improving breathing patterns and lung capacity, enabling early ambulation, and promoting a safe return to functional activities. Lifestyle modification, including exercise, diet, medication, and psychological support, is essential.
- Abdominal surgery rehabilitation focuses on core strengthening to maintain function and flexibility, reduce pain, promote rapid healing, and prevent respiratory complications. Special attention should be given to post-LSCS rehabilitation, emphasizing pelvic floor activation, swelling reduction, core engagement, scar care, and breastfeeding positioning.
- Neurological surgeries often lead to both physical and cognitive impairments, necessitating comprehensive rehabilitation. While timelines vary, the initial phase focuses on preventing complications and restoring strength. Subsequent phases aim to improve functional activities and maximize independence within the patient's remaining abilities.
- Transplant patients require rehabilitation to address cardiovascular risk and improve overall health. WHO recommends specific aerobic activity levels for these patients. Rehabilitation programs should include warm-up, circuit training, cool-down, strengthening, cardiovascular exercise, flexibility, and endurance components.
- Setting effective goals using the SMART framework is crucial for successful rehabilitation. Goals should be specific, measurable, achievable, relevant, and time-bound, providing direction, motivation, and clarity throughout the recovery process.
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About the Speakers
Dr. Namita Sharma
Head of the Department Anesthesiology and Pain Management, Aakash Healthcare, Delhi
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