Postoperative Evaluation and Pain Control
inadequate sensory block, NRS, pain
COMPLICATIONS
Standardly, pain scores (NRS) were assessed by the ward nurse once every 8 h and after each intervention for pain. Additionally, a dedicated pain team evaluated pain control at POD 1 in all patients and hereafter daily in patients receiving epidural analgesia, intravenous opioids, or patients in whom pain control was difficult. This pain team evaluated pain scores in combination with opioid consumption, side effects, and complications, and in case of epidural analgesia, the epidural sensory block range was tested. An NRS < 4 in rest and < 6 while mobilizing was generally considered to be acceptable. In case of insufficient pain control with opioids, analgesics daily opioid dose was increased, or non-opioids were added (for example, NSAIDs or esketamine). In case of epidural analgesia with an inadequate sensory block, an epidural top-up was performed, and continuous infusion was increased if a top-up was successful. If a top-up was unsuccessful, the epidural was removed and the patient switched to intravenous or oral opioids. Opioids were removed from the epidural mixture in patients who received opioids parallel to epidural analgesia. In case of sufficient pain control, intravenous opioids or epidural analgesia was gradually switched to oral opioids and then to paracetamol only.