Respiratory effects

Pain from abdominal or thoracic surgery commonly results in a deterioration of the patient's pulmonary function. The painful stimulus triggers spinal reflex responses which result in spasms of the chest and/or abdominal wall muscles. Such 'muscle splinting' also affects the diaphragm. As a result of these reflexes, the patient is unable to breathe or cough sufficiently and voluntarily reduces inspiratory or exspiratory efforts. These changes lead to decreases in tidal volume, forced vital capacity, functional residual capacity, and forced expiratory volume. Subsequently, atelectasis occurs which worsens the ventilation-perfusion ratio and finally results in hypoxemia and an increased risk of pulmonary infection. Adequate pain treatment prevents these adverse effects. For instance, in patients undergoing abdominal aortic aneurysm repair, significant decreases in time of intubation, time in the ICU, and cardiac and pulmonary complications have been achieved by agressive pain treatment (Kehlet ,1993).

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