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Natural childbirth is the dream of almost all women in labor; only a few patients insist on a caesarean section. Surgical delivery entails a number of negative consequences for the mother: a long rehabilitation period, prolonged healing of the suture and restoration of the female reproductive system.

How long does the stitch hurt? How long does it take for an incision to heal? Why does a mother's stitches pull after surgical birth? What other complications should a woman be wary of after a cesarean section during the first 2 years?

Sutures after cesarean section: what are they?

All women in labor after a cesarean section worry about the condition of the suture. A new mother is concerned about possible discomfort, pain, the appearance of the incision, as well as what kind of clothing can be used to hide it. Complications, healing time and nuances in care are determined by the type of suture. Modern obstetricians-gynecologists distinguish the following types:

• Vertical section. It is done during ECS, the indication for which is severe bleeding in a woman in labor or a lack of oxygen in the baby. The surgeon’s actions must be lightning fast; he performs a corporal cesarean section, cutting tissue from the navel to the pubis (more details in the article:). The suture after such an operation looks aesthetically unattractive and heals in knots.
• Horizontal section. It is applied during a planned operation. The doctor makes a laparotomy incision without the need to open the abdominal wall. An incision is made in the first skin fold from the pubis. This seam can be hidden with underwear; over time it becomes thin and almost invisible.
• Internal cut. It closes the uterine wall. Depending on the type of cesarean section, doctors apply a longitudinal or transverse suture.

How long does it take to heal?

The course of the rehabilitation period largely depends on the individual characteristics of the woman’s body, on her attitude towards her health. The Caesarean section operation has saved many women and helped the birth of millions of children - it is one of the most frequently performed operations in the world.

If the postoperative period during the first 5–7 days proceeds without complications in the form of suppuration or the formation of inflammatory foci, a scar will form at the incision site. The duration of healing depends on the type of surgery and the threads used to secure the incision. If the surgeon used silk threads, they will be removed after a week for a longitudinal scar or after 10 days for a vertical one. If cosmetic threads were used during the operation, they will disappear (dissolve) on their own after 2–3 months. Removing the silk threads does not mean that the scar has completely healed.

At first, the scar will have a blue-violet color, but over time it lightens, becomes thinner, and does not stand out much on the skin. The following manifestations after surgical delivery are considered the absolute norm: short-term itching, tingling, numbness, burning in the suture area.

The duration of the rehabilitation period and the risk of complications depends on several factors:

• Age. The younger the woman in labor, the sooner her scar heals and the fewer complications arise in the postoperative period.
• Builds. Body type matters a lot. Sutures will take longer to heal in obese women who have extra folds on their abdomen.
• Mobility. Pregnant women who lead a sedentary lifestyle have weak labor activity, which leads to ECS.
• Second birth. If the cesarean section is repeated, the sutures heal faster and the risk of discomfort is minimized (see also:).

The internal suture on the uterus takes longer to heal, so doctors recommend that women refrain from another pregnancy for at least 1.5–2 years. This is the optimal time for complete healing. If pregnancy occurs earlier, the risk of seam divergence increases - it may not be able to withstand the load from the baby growing inside.

Why does the seam hurt and pull?

Understanding the technique of performing a cesarean section will help you find out why the suture hurts or pulls. In order to get the baby out, doctors open the skin, subcutaneous tissue, muscles, and uterus, as a result of which the scalpel can damage blood vessels and nerve endings. The body reacts to such serious damage by releasing hormones that cause vasospasm. Other unpleasant consequences after a cesarean section include:

• Impaired blood flow. Nutrients cannot reach damaged tissues, so the healing process is somewhat delayed.
• Increased pain. Acids accumulate along the edges of the incision, which further irritate the wound surface and increase pain.

If the inflammatory process begins at this moment, healing will take much longer than usual. Factors influencing the duration of discomfort in the suture area:

• Seam pressure on fabric. In this case, the patient complains that she has pain and pulls the seam. The situation can be resolved by taking painkillers.
• Inelasticity. Many mothers turn to the gynecologist a month after the operation with complaints that their scar hurts. The reason is its inelasticity. When the abdomen is tense, the rough tissues stretch, causing pain. It usually subsides 6–12 months after surgery.
• Gas formation in the intestines. During the operation, the integrity of the peritoneum is compromised, which negatively affects the functionality of the gastrointestinal tract. Therapy includes a course of drugs to improve intestinal motility.
• Spikes. Quite often, adhesions form at the site of tissue scarring - this delays the healing process for several months.
• Contraction of the uterus. After childbirth, the empty uterus should return to its previous size. The faster the contraction occurs, the sooner the pain in the abdominal area will stop.

Signs of seam divergence

After the doctor has explained the question of how much the suture normally hurts after a cesarean section, you should pay attention to unpleasant moments, one of which is the suture dehiscence. This happens due to disturbances in the healing process - a hidden infection does not allow the edges of the tissue to grow together correctly, so on one side or in the middle the scar begins to diverge. If a woman ignored the recommendations and began lifting heavy objects or began active sports, the fault for the divergence of the seam lies with her. Symptoms of discrepancy:

• pus;
• heavy bleeding.

Disclosure of the tissue requires immediate contact with the maternity hospital. Having seen blood or pus emerging from the suture, the patient must contact the maternity hospital where she was operated on to determine the cause of the discrepancy and eliminate it. Unreasonable pain, accompanied by severe vaginal and uterine discharge, may indicate a divergence of the external suture. If a woman’s external suture is torn, the same situation can happen with the internal one - the sooner the surgeon examines her, the better.

Suture dehiscence after cesarean section is fraught with severe bleeding and death.

How to properly care for a seam?

While the woman is in the maternity hospital, a nurse takes care of the suture. Upon arrival home, responsibility falls on the new mother. Doctors give several simple recommendations that will help speed up healing and reduce the risk of complications to zero. These include:

• taking painkillers prescribed by a doctor;
• treating the seam with drying antiseptics (brilliant green, iodine, potassium permanganate) (more details in the article:);
• mobility – on the second day after surgery it is necessary to forcefully stand up and walk, increasing the load daily;
• regular showering without using soap in the area of ​​the seam;
• limiting warm baths and washcloth use;
• wearing a postoperative bandage throughout the day with a night break.

Possible complications

After any operation there is a risk of complications, caesarean section is no exception. It is important for the patient to promptly respond to poor health and seek qualified medical help. When preparing for surgery, a woman needs to understand what she may encounter during and after a cesarean section:

• heavy blood loss during surgery;
• the formation of adhesions, as a result – disruptions in the normal functioning of the peritoneal organs;
• endometritis – extensive inflammation of the uterus;
• formation of a hematoma near the suture;
• bleeding from the incision site;
• purulent inflammation of the suture;
• seam divergence.

In the future, the woman may have other problems. If treatment is not timely, patients are faced with:

• ligature fistulas - gaps through which infection can penetrate;
• a hernia that occurs during a longitudinal incision or several operations on the abdominal cavity;
• keloid scar – partial or complete thickening of scar tissue;
• individual intolerance, allergic reaction to an anesthetic drug;
• injury to the throat by a tracheal tube;
• aspiration - the entry of gastric juice into the lungs.

Complications after spinal and epidural anesthesia also worry many patients. These include:

• a sharp decrease in blood pressure in the mother - there is a threat to the life of the woman and child;
• oxygen starvation of the fetus;
• headache, discomfort at the site of anesthetic injection;
• anesthetic intoxication;
• damage to the spinal cord, resulting in cardiac arrest;
• a decrease in the child’s vital signs due to anesthetics entering his bloodstream.

What to do if the stitch hurts after surgery? This question is often asked by people who have undergone surgery. Often, pain in the abdominal area is not related to the complicated course of tissue scarring. It can occur during the process of wound healing, skin fusion, and the return of organs to their usual places. Pain in such cases should not be a cause for concern; it is completely normal. However, it also happens that discomfort does not leave a person even several months after surgery.

Cause of the problem

If the cosmetic stitch begins to hurt several weeks or even months after surgery, you should consult a doctor. There can be quite a few reasons for this phenomenon. First of all, these are inflammatory processes associated with the addition of a bacterial infection. The appearance of unpleasant sensations depends on the characteristics of the body, susceptibility to stressful situations, and the presence of disturbances in the functioning of the immune system. An important role is played by the qualifications of the surgeons, the complexity of the intervention, the type of instruments used, the technique of applying suture material and the correctness of all manipulations.

Normally, a surgical suture should hurt for no more than 7 days; minor deviations from this value are acceptable. People's skin and muscle tissue may differ, so it is impossible to accurately determine the duration of pain.

It is necessary to consult a doctor if discomfort persists for several weeks. It is possible that errors were made during the surgical intervention, as a result of which an acute inflammatory process developed.

If the pain cannot be relieved with standard pain medications, a full examination is necessary. The operation may need to be repeated.

The stitch almost always hurts and pulls after surgery if it was a cavity operation. In such cases, not only the skin and subcutaneous tissue are dissected, but also muscle tissue and large vessels. To reduce the intensity of unpleasant sensations, the doctor prescribes special medications and procedures, the use of which requires compliance with a number of rules. During the treatment period, it is recommended to refrain from driving, especially if the person is not sure how he will behave in emergency situations. Slow walks are useful, but it is recommended to avoid climbing stairs.

Long flights and transfers adversely affect the well-being of even a healthy person, and in the postoperative period they can lead to serious consequences. You cannot lift weights weighing more than 3 kg, or carry children or animals. After improving the general condition of the body, you can introduce light physical activity into your daily routine. You should avoid visiting bathhouses, saunas and solariums.

Daily care of the postoperative scar is necessary. The seam must be cleaned of dirt and crusts, treated with antiseptic solutions and covered with a protective bandage. Slight redness of the affected area is considered normal. You should not peel off the patch yourself; after a certain period of time it will come off on its own. Lumps and a feeling of tightness in the scar area may appear. There is no need to worry, these are natural sensations that accompany the healing process.

Exposure to direct sunlight can disrupt the scarring process, so it is recommended to wear covered clothing in the first months after surgery. In the first days after surgery, blood spots may be found on the bandage. If they are small in size, there is no need to worry. If the scar bleeds heavily, you should immediately consult a doctor.

Do not use any external agents without a doctor's permission. You can shower no earlier than 3 days after surgery. Over the course of several months, the crust comes off the scar and it becomes less hard and bright. Why does the stitch hurt after a cesarean section? This question worries many young mothers who have undergone this operation.

Causes of suture pain after cesarean section

This operation can be performed in several ways. Corporal caesarean section is prescribed for the development of massive bleeding during childbirth. This method is used quite rarely, since it leaves a large scar that expands over time. Corporal surgery - dissection of tissue from the midline of the abdomen to the pubis. A longitudinal incision is made on the wall of the uterus. In the absence of complications, Pfannenstiel laparotomy is used. The incision runs along the suprapubic fold.

Unlike a longitudinal one, a transverse incision becomes less noticeable over time and postoperative pain is less intense, which is the main advantage of this operation. The operation is completed with the application of absorbable suture material. During a corporal caesarean section, the postoperative scar must be highly durable, so a cosmetic suture is not used in this case. In the first days after the operation, the patient feels acute pain associated with the presence of incisions in the uterus and abdominal wall. It is practically no different from that of other surgical interventions.

Drugs

In the postoperative period, the doctor prescribes antibacterial and painkillers. On the first day, narcotic analgesics are used: Tramadol, Morphine, Omnopon. Over time, they are replaced with weaker agents, the action of which is aimed at reducing the intensity of pain. It is the pain of the suture after surgery that is the reason why women fear a cesarean section. Unpleasant sensations disappear quickly, you just need to take all the medications prescribed by your doctor and properly care for the suture.

Moderately traumatic surgical interventions can cause significant pain after surgery. At the same time, traditional opioids (morphine, promedol, etc.) are not suitable for patients after such operations, since their use, especially in the early period after general anesthesia, is dangerous for the development of central respiratory depression and requires monitoring the patient in an intensive care unit. Meanwhile, due to their condition, patients after such operations do not require hospitalization in the intensive care unit, but they require good and safe pain relief.

Almost everyone experiences some pain after surgery. In the world of medicine, this is considered more of a norm than a pathology. After all, any operation is an intervention in the entire system of the human body, so it takes some time to recover and heal wounds for further full functioning. Pain sensations are purely individual and depend both on the postoperative condition of the person and on the general criteria of his health. Pain after surgery can be constant, or it can be intermittent, intensifying with body tension - walking, laughing, sneezing or coughing, or even deep breathing.

Causes of pain after surgery

Pain after surgery can be of different nature. This may indicate the process of wound healing and tissue fusion, because when surgical incision of soft tissue occurs, some small nerve fibers are damaged. This increases sensitivity of the injured area. Other causes of pain after surgery are tissue swelling. In addition, much depends on how carefully the doctor performs the operation itself and manipulates the tissues, as this can also cause additional injury.

Symptoms of pain after surgery

A person may not associate the pain that occurs with the previous operation. But there are a number of signs that will help determine pain after surgery. First of all, you should pay attention to the general condition: pain after surgery is often accompanied by sleep and appetite disturbances, general weakness, lethargy, drowsiness, and decreased activity. These pains can also cause decreased concentration, difficulty breathing or coughing. These are the most obvious and easily recognized symptoms of pain after surgery, and if they occur, you should definitely consult a doctor.

Pain after varicocele surgery

Varicocele is a fairly common disease these days. The disease itself is not life-threatening, but it causes many problems for a man, both physiological and psychological. Pain after varicocele surgery can be caused by various factors. The most dangerous of them is damage during surgery to the genital-femoral nerve, which is located in the inguinal canal. Pain is felt in the area of ​​the surgical wound and may be accompanied by a decrease in sensitivity of the inner thigh. Another reason why pain may occur after varicocele surgery may be an infectious process in the postoperative wound. To avoid this complication, you should do dressings only with a specialist and, as far as possible, avoid contact of the operated area with all possible sources of infection. Also, pain after varicocele surgery may indicate testicular hypertrophy or atrophy. Thanks to modern medical technologies, after surgical procedures in most cases, and this is about 96% of those undergoing surgery, no complications arise, therefore pain should be a signal that you should definitely consult a doctor, since there is always a chance of being among the 4% of other patients.

Pain after appendicitis surgery

Removing the appendix is ​​a fairly common and simple operation these days. Most surgeries are relatively easy and without complications. Patients generally recover within three to four days. Pain after appendicitis surgery may indicate complications that have arisen. If the pain is cutting in nature, this may be a sign that there is a slight divergence of the internal seams as a result of overexertion. Nagging pain after appendicitis surgery may indicate that adhesions are occurring, which can subsequently affect the functioning of other pelvic organs. If these pains are too sharp, then there is a possibility that the intestines are being compressed, which can have an unfavorable outcome without medical intervention. Stress on the intestines can also cause pain after appendicitis removal, so you should carefully monitor your diet in the first time after surgery. In addition, you should handle the postoperative suture as carefully as possible to avoid infection and suppuration in the postoperative area.

Abdominal pain after surgery

After abdominal surgery (as after any other surgical procedure), the body's tissues need time to recover and heal. This process is accompanied by mild painful sensations, which decrease over time. But if abdominal pain becomes very intense after surgery, this may indicate some kind of inflammation at the operation site. Also, abdominal pain after surgery can cause the formation of adhesions. People with increased weather sensitivity may experience aching pain at the surgical site depending on changing weather conditions. Abdominal pain after surgery may be accompanied by nausea, dizziness, burning in the postoperative area, and redness. If such symptoms occur, you should consult a specialist.

Pain after inguinal hernia surgery

After an inguinal hernia operation, there is a slight pain syndrome for some time after the operation, which disappears as the sutures and tissues heal. After a short period of time after the operation, the patient can already move independently, but when walking he still feels pain in the abdominal area. Pain after inguinal hernia surgery may not always indicate problems with the scar. This can be pain of both a neurological and muscular nature. But with heavy loads in the postoperative period, relapses may occur, which are accompanied by severe pain and require repeated surgical intervention. Painful sensations at the suture site can be a sign of both external and internal suture dehiscence.

Pain after spinal surgery

Some time after spinal surgery, characteristic pain may occur in the area of ​​the operated area. Most often, pain after spinal surgery indicates poor-quality surgery, which subsequently leads to the development of a postoperative scar - fibrosis. This complication is characterized by specific pain that appears after several weeks of feeling well. Pain after spinal surgery in most cases has neurological causes. It may also be relapses of the disease caused by improper adherence to the postoperative regimen. Most patients experience pain after spinal surgery, but the intensity should decrease as they recover. Recovery usually takes three to six months. In case of too intense pain, there are a number of methods to solve this problem, from drug treatment to consultation with neurosurgeons and repeated surgery. Spinal surgery is one of the most difficult and dangerous operations and often entails complications, so any pain after spinal surgery should not be ignored.

Back pain after surgery

After surgery, back pain often persists. This can be caused by a variety of reasons, such as scarring, neurological symptoms, or various pinching or misalignments in the spinal area. To avoid complications after surgery, you must carefully follow the doctor’s recommendations regarding the rehabilitation program. You may also experience back pain after a cesarean section. This is a fairly common problem that should not be ignored, because during pregnancy and surgery there is a strong load on the woman’s spine, which can result in various injuries. Often after surgical operations, pain appears in the lower back, in the lower back. This is due to the formation of adhesions and the negative impact of scar changes. Pain between the shoulder blades often appears after breast surgery, with tension in the rhomboid muscle. Quite often, spinal anesthesia is used during operations, which can subsequently cause aching pain in the back.

Headache after surgery

Headache after surgery is associated with the peculiarities of surgical procedures or signals an increase in intraocular pressure due to surgery. Also, headache after surgery can be a consequence of anesthesia, especially if the pain is accompanied by nausea and dizziness. This is a rather dangerous symptom, which in any case requires urgent consultation with a neurologist or the doctor who performed the operation. After spinal anesthesia, complaints of headaches are more common than after conventional general anesthesia. This complication occurs when too large a hole has been made in the spinal cord, resulting in a significant increase in intracranial pressure. If in this case the pain is very severe, then the hole is filled with blood. Also, headache after surgery can be a side effect of medications prescribed for the postoperative period.

Pain after hemorrhoid surgery

If pain after hemorrhoid surgery persists for a long period, which exceeds the rehabilitation period predicted by the doctor, then the postoperative treatment is not sufficient or is not effective in a particular case and requires immediate correction. Severe pain after hemorrhoid surgery may be due to scarring. In cases where the scars are too dense, intestinal ruptures may occur, which will be repeated each time during bowel movements. Also, pain after hemorrhoid surgery may indicate the entry of pathogenic microflora into the postoperative wound and, accordingly, suppuration. One of the unpleasant causes of pain can be a fistula, which requires serious treatment. Pain after hemorrhoid surgery should decrease as the wound heals and tissue repairs.

Pain after abdominal surgery

During each operation, the entire human organ system takes on a huge load. This process is accompanied by a significant stress state, which is enhanced by the presence of pain after abdominal surgery. The body's reaction to open surgery can last up to three days and is expressed in severe pain, increased temperature or pressure, and tachycardia. Because of this, quite often during the rehabilitation period patients develop a depressed mood and decreased activity, which significantly slows down the recovery process. Pain after abdominal surgery is relieved by opiate drugs, sedatives and anti-inflammatory drugs. While taking the medications, the pain after abdominal surgery decreases, body temperature returns to normal, and motor activity increases. Over time, the body recovers almost completely; there may be complaints only of minor pain in the abdomen, which also completely disappears over time. After three to four weeks, subject to the rehabilitation routine and diet, the body’s activity stabilizes, swelling goes away, pain disappears and a scar forms.

Pain after lung surgery

If severe chest pain appears after lung surgery, this is an alarming signal that you need to see a doctor. Such pain may be a symptom of pulmonary hemorrhage that appears as a complication after surgery. Also, pain after lung surgery may indicate the formation of adhesions. Adhesions themselves are not a disease and do not always require medical intervention, but if the adhesions process is accompanied by a cough, fever and poor general health, then this may require treatment. Pain after lung surgery can occur with sudden physical activity, which may be a sign of inflammation or suppuration in the operated area. Lung operations are very serious operations, which often result in complications. In the first time after surgery, the body is supplied with oxygen an order of magnitude worse, which can cause headaches, difficulty breathing and tachycardia. Resistance to diseases such as bronchitis or pneumonia also increases. In addition, it is worth remembering that after surgery the lungs increase in volume, filling the free space, which can lead to displacement of other organs in the chest. All this can cause pain after lung surgery.

Muscle pain after surgery

Most often, muscle pain after surgery occurs in young men. Pain syndrome is usually associated with the use of curare-like drugs during anesthesia, which relax the muscles. Such drugs are used in emergency situations or in cases where food was eaten shortly before the operation and the stomach remains full during the operation. Muscle pain after surgery is a consequence of anesthesia. Usually these pains are “wandering”, they are symmetrical and affect the shoulder girdle, neck or upper abdomen. If the rehabilitation period is favorable, muscle pain after surgery disappears after a few days. Also, nagging muscle pain appears after laparoscopy and continues for some time until complete recovery. In addition, long after surgery, aching pain in the muscles near the postoperative scar may remain, as a reaction to weather changes.

How to relieve pain after surgery?

Most people experience unpleasant pain of varying intensity after surgery. Such pain can have a different nature and duration and intensify with certain body positions or movements. If the pain becomes too severe, narcotic analgesics are usually used. These drugs are most effective in cases where the patient needs to get out of bed or the pain cannot be tolerated and weaker painkillers do not help. In some cases, the dosage of these drugs may be increased or supplemented with other medications. It should be noted that these types of drugs can cause addiction and negative reactions in the body, so they should be taken as needed and under the supervision of a doctor or medical staff. Under no circumstances should you take strong painkillers that have a narcotic effect on your own. This may lead to side effects such as nausea, excessive sedation, and disruption of the favorable course of rehabilitation. It is worth contacting your attending physician, who will describe how to relieve pain after surgery, taking into account the individual characteristics of the surgical procedures performed and the body. For moderate pain, doctors recommend using non-narcotic analgesics. This is paracetamol, which, with the correct dosage, practically does not cause any side effects from the body and has high tolerance. There are many traditional ways to relieve pain after surgery, but traditional doctors strongly advise against self-medication, since in the postoperative period the body is most susceptible to all kinds of irritants and may respond inadequately to self-medication.

To protect against pain after surgery with an emphasis on preventive (before injury and pain occurs) protection, it is recommended to use the principle of multimodality and use an integrated approach. When drawing up a plan for postoperative analgesia, a number of general principles should be followed:

• therapy should be etiopathogenetic (if the pain is spastic in nature after surgery, it is enough to prescribe an antispasmodic, not an analgesic);
• the prescribed drug must be adequate to the intensity of pain after surgery and be safe for humans, not cause significant side effects (respiratory depression, decreased blood pressure, rhythm disorders);
• the duration of use of narcotic drugs and their dose should be determined individually depending on the type, causes and nature of the pain syndrome;
• drug monotherapy should not be used; a narcotic analgesic for pain relief after surgery, in order to increase efficiency, should be combined with non-narcotic drugs and adjuvant symptomatic drugs of various assortments;
• Pain relief should be prescribed only when the nature and cause of pain are recognized and a diagnosis is established. Relieving the symptom of pain after surgery for an unknown reason is unacceptable. When implementing these general principles, every doctor should, as Professor N.E. points out. Burov, know the pharmacodynamics of the main range of painkillers and the pharmacodynamics of the main adjuvant drugs (antispasmodics, anticholinergics, antiemetics, corticosteroids, antidepressants for anxiety-hypnotic conditions, anticonvulsants, antipsychotics, tranquilizers, antihistamines, sedatives), assess the intensity of pain after surgery and depending on this apply uniform tactics.

To ensure uniformity of tactics, it was proposed to use a scale for assessing pain intensity after surgery. The role of such a scale is the “analgesic ladder” developed by the World Federation of Societies of Anesthesiology (WFOA). The use of this scale allows one to achieve satisfactory pain relief in 90% of cases. The scale provides a gradation of pain severity after surgery.

At the 3rd stage - minimally expressed pain after surgery - monotherapy with non-narcotic drugs is carried out to relieve pain.

At the 2nd stage, a combination of non-narcotic analgesics and weak opioids is used, mainly with their oral administration. The most specific and reliable option for pain relief after surgery seems to be the effect on the central link, therefore, centrally acting drugs are predominantly used to relieve pain after surgery. Examples of such analgesics include butorphanol and nalbuphine.

Butorphanol tartrate is a kappa agonist and a weak mu-opioid receptor antagonist. As a result of interaction with kappa receptors, butorphanol has strong analgesic properties and sedation, and as a result of antagonism with mu receptors, butorphanol tartrate weakens the main side effects of morphine-like drugs and has a more beneficial effect on respiration and blood circulation. For more severe pain, buprenorphine is prescribed. The analgesic effect of butorphanol tartrate with intravenous administration occurs within 15-20 minutes.

Nalbuphine is a new generation of synthetic opioid analgesics. In its pure form at a dose of 40-60 mg, it is used for postoperative pain relief during extracavitary operations. During intracavitary major operations, monoanalgesia with nalbuphine becomes insufficient. In such cases, it should be combined with non-narcotic analgesics. Nalbuphine should not be used in combination with narcotic analgesics due to their mutual antagonism.

The direction of creating combined drugs with different mechanisms and time characteristics of action also seems promising. This makes it possible to achieve a stronger analgesic effect compared to each of the drugs at lower doses, as well as a reduction in the frequency and severity of adverse events.

In this regard, combinations of drugs in one tablet are very promising, making it possible to significantly simplify the dosage regimen. The disadvantage of such drugs is the inability to vary the dose of each component separately.

At the 1st stage - for severe pain - strong analgesics are used in combination with regional blockades and non-narcotic analgesics (NSAIDs, paracetamol), mainly parenterally. For example, strong opioids can be administered subcutaneously or intramuscularly. If such therapy does not have sufficient effect, the drugs are administered intravenously. The disadvantage of this route of administration is the risk of severe respiratory depression and the development of arterial hypotension. Side effects such as drowsiness, adynamia, nausea, vomiting, impaired motility of the digestive tract, and motility of the urinary tract are also noted.

Medicines to relieve pain after surgery

Most often in the postoperative period it is necessary to relieve pain after surgery at the 2nd stage level. Let's take a closer look at the medications used in this case.

Paracetamol is a non-selective inhibitor of COX-1 and COX-2, acting primarily in the central nervous system. It inhibits prostaglandin synthetase in the hypothalamus, prevents the production of spinal prostaglandin E2 and inhibits the synthesis of nitric oxide in macrophages.

At therapeutic doses, the inhibitory effect in peripheral tissues is insignificant, it has minimal anti-inflammatory and anti-rheumatic effects.

The action begins quickly (after 0.5 hours) and reaches a maximum after 30-36 minutes, but remains relatively short (about 2 hours). This limits the possibilities of its use in the postoperative period.

For the treatment of pain after surgery, a 2001 systematic review of high-quality evidence examining 41 high-quality studies found that the effectiveness of a 1000 mg dose after orthopedic and abdominal surgery was similar to other NSAIDs. In addition, its rectal form has been shown to be effective at a dose of 40-60 mg/kg once (1 study) or 14-20 mg/kg repeatedly (3 studies), but not 10-20 mg/kg once (5 studies).

The advantage is the low incidence of side effects when using it; it is considered one of the safest analgesics and antipyretics.

Tramadol remains the fourth most commonly prescribed analgesic in the world, used in 70 countries. Moreover, in 4% of cases it is prescribed to treat pain after surgery.

Tramadol, a synthetic opioid analgesic, is a mixture of two enantiomers. One of its enantiomers interacts with opioid mu-, delta- and kappa receptors (with greater tropism for mu-receptors). The main metabolite (Ml) also has an analgesic effect, and its affinity for opiate receptors is almost 200 times greater than that of the parent substance. The affinity of tramadol and its Ml metabolite for mu receptors is much weaker than the affinity of morphine and other true opiates, so although it exhibits an opioid effect, it is an analgesic of moderate strength. Another enantiomer inhibits the neuronal uptake of norepinephrine and serotonin, activating the central descending inhibitory noradrenergic system and disrupting the transmission of pain impulses to the gelatinous substance of the brain. It is the synergism of its two mechanisms of action that determines its high efficiency.

It should be noted that it has low affinity for opiate receptors, due to which it rarely causes mental and physical dependence. The results obtained over a 3-year study of the drug after its introduction to the market in the United States indicate that the degree of development of drug dependence was low. The overwhelming majority of cases of drug dependence (97%) were identified among individuals who had a history of drug dependence on other substances.

The drug does not have a significant effect on hemodynamic parameters, respiratory function and intestinal motility. In postoperative patients under the influence of tramadol in the range of therapeutic doses from 0.5 to 2 mg per 1 kg of body weight, even with intravenous bolus administration, significant respiratory depression was not established, while morphine at a therapeutic dose of 0.14 mg/kg was statistically significant and significantly reduced the respiratory rate and increased the CO2 tension in the exhaled air.

Tramadol also does not have a depressing effect on blood circulation. On the contrary, when administered intravenously at 0.75-1.5 mg/kg, it can increase systolic and diastolic blood pressure by 10-15 mm Hg. Art. and slightly increase the heart rate with a rapid return to initial values, which is explained by the sympathomimetic component of its action. There was no effect of drugs on the level of histamine in the blood or on mental functions.

Postoperative pain relief based on tramadol has proven positive in elderly and senile people due to the absence of a negative effect on the functions of the aging body. It has been shown that epidural block use in the postoperative period after major abdominal interventions and after cesarean section provides adequate pain relief after surgery.

The maximum activity of tramadol develops after 2-3 hours, the half-life and duration of analgesia are about 6 hours. Therefore, its use in combination with other, faster-acting painkillers seems more favorable.

Combination of medications to relieve pain after surgery

Combinations of paracetamol with opioids are recommended for use by WHO and are the best-selling combination painkillers for pain relief after surgery abroad. In the UK in 1995, the number of prescriptions of paracetamol with codeine (paracetamol 300 mg and codeine 30 mg) accounted for 20% of all analgesic prescriptions.

The use of the following drugs in this group is recommended: Solpadeine (paracetamol 500 mg, codeine 8 mg, caffeine 30 mg); Sedalgina-Neo (acetylsalicylic acid 200 mg, phenacetin 200 mg, caffeine 50 mg, codeine 10 mg, phenobarbital 25 mg); Pentalgin (metamizole 300 mg, naproxen 100 mg, caffeine 50 mg, codeine 8 mg, phenobarbital 10 mg); Nurofena-Plus (ibuprofen 200 mg, codeine 10 mg).

However, the potency of these drugs is not sufficient for their widespread use for pain relief after surgery.

Zaldiar is a combination drug of paracetamol and tramadol. Zaldiar was registered in Russia in 2004 and is recommended for use in the treatment of dental pain and pain after surgery, back pain, osteoarthritic pain and fibromyalgia, pain relief after minor and moderately traumatic surgical interventions (arthroscopy, hernia repair, sectoral resection of the mammary gland, resection of the thyroid gland, saphenectomy).

One Zaldiar tablet contains 37.5 mg of tramadol hydrochloride and 325 mg of paracetamol. The choice of dose ratio (1: 8.67) was made based on the analysis of pharmacological properties and has been proven in a number of in vitro studies. In addition, the analgesic efficacy of this combination was studied in a pharmacokinetic/pharmacodynamic model in 1,652 subjects. It has been shown that the analgesic effect when taking Zaldiar occurs in less than 20 minutes and lasts up to 6 hours; Thus, the action of Zaldiar develops twice as fast as that of tramadol, lasts 66% longer than tramadol, and 15% longer than paracetamol. At the same time, the pharmacokinetic parameters of Zaldiar do not differ from the pharmacokinetic parameters of its active ingredients and no undesirable drug interactions occur between them.

The clinical effectiveness of the combination of tramadol and paracetamol was high and exceeded the effectiveness of tramadol monotherapy at a dose of 75 mg.

To compare the analgesic effects of two multicomponent analgesics, tramadol 37.5 mg/paracetamol 325 mg and codeine 30 mg/paracetamol 300 mg, a double-blind, placebo-controlled study was conducted in 153 people for 6 days after knee and shoulder arthroscopy. On average across groups, the daily dose of tramadol/paracetamol was comparable to that of codeine/paracetamol, which were 4.3 and 4.6 tablets per day, respectively. The effectiveness of the combination of tramadol and paracetamol was higher than in the placebo group. According to the final assessment of the result of pain relief, the intensity of pain during the day was higher in the group of patients who were anesthetized with a combination of codeine and paracetamol. In the group receiving a combination of tramadol and paracetamol, a more pronounced reduction in pain intensity was achieved. In addition, adverse events (nausea, constipation) occurred less frequently with tramadol and paracetamol than with codeine and paracetamol. Therefore, combining tramadol 37.5 mg and paracetamol 325 mg reduces the average daily dose of the former, which in this study was 161 mg.

A number of clinical trials of Zaldiar in dental surgery have been conducted. A double-blind, randomized comparative study conducted in 200 adult patients after molar extraction showed that the combination of tramadol (75 mg) with paracetamol was as effective as the combination of paracetamol with hydrocodone (10 mg), but was less likely to cause side effects. A double-blind, randomized, placebo-controlled, multicenter study of 1,200 patients undergoing molar extraction compared the analgesic efficacy and tolerability of tramadol 75 mg, paracetamol 650 mg, ibuprofen 400 mg, and the combination of tramadol 75 mg with paracetamol 650 mg after a single dose was also conducted. PM. The total analgesic effect of the combination of tramadol and paracetamol was 12.1 points and was higher compared to placebo, tramadol and paracetamol used as monotherapy. In patients of these groups, the total analgesic effect was 3.3, 6.7 and 8.6 points, respectively. The onset of action for analgesia with a combination of tramadol and paracetamol was observed on average for the group at the 17th minute (with a 95% confidence interval from 15 to 20 minutes), while after taking tramadol and ibuprofen the development of analgesia was noted at the 51st minute (at 95 % confidence interval from 40 to 70 minutes) and 34 minutes, respectively.

Thus, the use of a combination based on tramadol and paracetamol was accompanied by an increase and prolongation of the analgesic effect, a more rapid development of the effect compared to that observed after taking tramadol and ibuprofen. The duration of the analgesic effect also turned out to be longer for the combined drugs tramadol and paracetamol (5 hours) compared to these substances separately (2 and 3 hours, respectively).

The Cochrane Collaboration conducted a meta-analysis (review) of 7 randomized, double-blind, placebo-controlled trials in which 1763 patients with moderate to severe postoperative pain received tramadol in combination with paracetamol or paracetamol or ibuprofen alone. The number of patients who needed analgesic therapy to reduce pain intensity by at least 50% in one patient was determined. It was revealed that in patients with moderate or severe pain after dental surgery, this indicator during 6 hours of observation for the combined drug tramadol with paracetamol was 2.6 points, for tramadol (75 mg) - 9.9 points, for paracetamol (650 mg) - 3.6 points.

Thus, the meta-analysis showed a higher effectiveness of Zaldiar compared to the use of individual components (tramadol and paracetamol).

In a simple open non-randomized study conducted at the Russian Scientific Center for Surgery of the Russian Academy of Medical Sciences in 27 patients (19 women and 8 men, whose average age was 47 ± 13 years, body weight - 81 ± 13 kg), with pain of moderate or severe intensity in the postoperative period, the administration of Zaldiar was started after complete restoration of consciousness and gastrointestinal function. The study included patients with acute pain after surgery caused by abdominal (laparoscopic cholecystectomy, hernia repair), thoracic (lobectomy, pleural puncture) and extracavitary (microdiscectomy, saphenectomy) surgical interventions.

Contraindications to the prescription of drugs were: inability to take orally, hypersensitivity to tramadol and paracetamol, use of centrally acting drugs (hypnotics, hypnotics, psychotropics, etc.), renal (creatinine clearance less than 10 ml/min) and liver failure, chronic obstructive pulmonary diseases with signs of respiratory failure, epilepsy, taking anticonvulsants, taking MAO inhibitors, pregnancy, breastfeeding.

Zaldiar was prescribed in standard doses: for pain, 2 tablets, while its maximum daily dose did not exceed 8 tablets. The duration of analgesic therapy ranged from 1 to 4 days. In case of insufficient pain relief or lack of effect, other analgesics were additionally prescribed (promedol 20 mg, diclofenac 75 mg).

Pain intensity was determined using a verbal scale (VS). The initial intensity of pain was recorded, as well as its dynamics for 6 hours after the first dose of Zaldiar; assessment of the analgesic effect on a 4-point scale: 0 points - no effect, 1 - slight (unsatisfactory), 2 - satisfactory, 3 - good, 4 - complete pain relief; duration of analgesic action; duration of course; the need to administer additional analgesics; registration of adverse events.

Additional administration of analgesics was required in 7 (26%) patients. Throughout the observation period, pain intensity according to the VS ranged from 1 ± 0.9 to 0.7 ± 0.7 cm, which corresponds to pain of low intensity. In only two patients, the use of Zaldiar was ineffective, which was the reason for discontinuation of treatment. The remaining patients rated pain relief as good or satisfactory.

Pain after surgery of moderate intensity according to VS occurred in 17 (63%) patients, severe pain in 10 (37%) patients. On average for the group, pain intensity according to VS was 2.4 ± 0.5 points. After the first dose of Zaldiar, adequate pain relief was achieved in 25 (93%) patients, incl. satisfactory and good/complete - in 4 (15%) and 21 (78%), respectively. A decrease in pain intensity after the initial dose of Zaldiar from 2.4 ± 0.5 to 1.4 ± 0.7 points was noted by the 30th minute (first assessment of pain intensity) of the study, and the maximum effect was observed after 2-4 hours, 24 ( 89%) of the patient indicated a clear reduction in pain intensity by at least half, and the duration of the analgesic effect was on average for the group 5 ± 2 hours. The average daily dose in the Zaldiar group was 4.4 ± 1.6 tablets.

Thus, the appointment of Zaldiar in case of severe pain after surgery or moderate intensity is advisable from the 2-3rd day of the postoperative period, 2 tablets. In this case, the maximum daily dose should not exceed 8 tablets.

The tolerability profile of Zaldiar, according to various studies, is relatively favorable. Side effects develop in 25-56% of cases. Thus, in a study during the treatment of osteoarthritis, nausea (17.3%), dizziness (11.7%) and vomiting (9.1%) were noted. At the same time, 12.7% of patients had to stop taking drugs due to side effects. No serious side effects were reported.

In a study in postoperative patients, drug tolerability and the frequency of adverse reactions during pain relief with the combination of tramadol 75 mg/paracetamol 650 mg were comparable to those in patients taking tramadol 75 mg as the only analgesic. The most common adverse events in these groups were nausea (23%), vomiting (21%) and drowsiness (5% of cases). Discontinuation of Zaldiar due to adverse events was required in 2 (7%) patients. None of the patients experienced clinically significant respiratory depression or an allergic reaction.

In a four-week multicenter comparative study of the use of tramadol/paracetamol (Zaldiar) and codeine/paracetamol combinations in patients with chronic pain after back surgery and pain due to osteoarthritis, Zaldiar, compared with the codeine/paracetamol combination, demonstrated a more favorable tolerability profile (such side effects were less frequently observed). effects such as constipation and drowsiness).

In a meta-analysis of the Cochrane Collaboration, the incidence of side effects with the combination drug tramadol (75 mg) with paracetamol (650 mg) was higher than for paracetamol (650 mg) and ibuprofen (400 mg): the index of potential harm (an indicator of the number of patients during treatment of which one case of side effect developed) was 5.4 (with a 95% confidence interval from 4.0 to 8.2). At the same time, monotherapy with paracetamol and ibuprofen did not increase the risk compared with placebo: the relative risk for them was 0.9 (with a 95% confidence interval of 0.7 to 1.3) and 0.7 (with a 95% confidence interval from 0.5 to 1.01) respectively.

When assessing adverse reactions, it was revealed that the combination of tramadol/paracetamol does not increase the toxicity of the opioid analgesic.

Thus, when relieving pain after surgery, the most appropriate is the planned use of one of the NSAIDs in the recommended daily dose in combination with tramadol, which makes it possible to achieve good analgesia in the active state of operated patients without serious side symptoms characteristic of morphine and promedol (drowsiness, lethargy, hypoventilation of the lungs ). The method of postoperative pain relief based on tramadol in combination with one of the peripheral analgesics is effective, safe, and allows pain relief for the patient in the general ward, without special intensive observation.

Pain after a cesarean section is something women remember for a long time after the operation. For some, they go away in the maternity hospital, while for others they persist for months, or even years. What to do if such a negative situation affects you and how long does the stitch hurt after a cesarean section - 1 month, 2 months or more, what is considered normal?

Pain that appears in the first month after surgery may be associated with poor hygiene and excessive physical exertion. By the way, they need to be excluded for at least 1.5, and preferably 3, months after surgery, since this can lead to suture divergence. And if the suture hurts after a cesarean section during the second pregnancy, then this may be a long-term consequence of female recklessness. It is advisable for the first month to arm yourself with physical help from relatives around the house and child care.

Caring for sutures after a caesarean section is carried out by nurses in the maternity hospital. A course of antibiotic therapy is also carried out there to prevent the inflammatory process. And a woman is discharged only if the stitch is in good condition. But why does the stitch hurt after a cesarean section? There can be many reasons.

1. Poor quality suture material that has not completely dissolved(in most cases, a cosmetic suture is applied during delivery surgery). This often happens if the inner seam is made using silk threads. If the threads have dissolved, and this should happen within 1-1.5 months, the suture on the uterus after a cesarean section should not hurt. If the thread remains, the woman shows signs of inflammation. Scientifically, this is called a ligature abscess. It causes a painful swelling with pus. This pus must be removed. A thread is usually found in the center of the abscess. The surgeon removes it and cleans the wound. Then you need to take antibiotics for several days. Usually all this happens in a hospital setting. You need to stay in the hospital for several days, as complications after the procedure are possible and rehabilitation is necessary.

2. If the internal suture hurts after a cesarean section, then the cause may be an adhesive process in the pelvic area. Some doctors who suspect this pathology in their patient prescribe an MRI to confirm it. But in this case, laparoscopy will be more informative. This way the doctor can see the adhesions with his own eyes and cut them. Thus, the patient will not experience pain in the future, and reproductive function will not be affected. After all, adhesions are the most common cause of ectopic pregnancy and infertility. Intestinal obstruction can also be a consequence. Can the suture hurt 6 months, a year, 2 years after a cesarean section? Yes, if the problem is the adhesive process.

3. Problems with gynecology. Sometimes such unpleasant sensations are not at all associated with the presence of a suture on the uterus. Painful sensations can be associated with inflammation of the uterus - endometritis, inflammation of the ovaries - adnexitis. And sometimes pathologies of the urinary system. A gynecologist will be able to accurately answer the question of where and what hurts after an examination in a gynecological chair. He will answer the question - the suture hurts and is inflamed after a cesarean section, what to do, or give a direction for additional studies, for example, an ultrasound of the pelvic organs, a urine test, a vaginal smear, if he believes that it is not the suture that is causing the pain.

4. The seam has come apart. This often happens during physical activity that is contraindicated in the first weeks after surgery. What should I do if, after a planned cesarean section, the suture hurts a lot due to its divergence? You should not do anything on your own. You need to contact a surgeon who will clean the wound. There will be no re-suturing. But they will probably prescribe antibiotic therapy. As a rule, the sutures come apart in the first days after surgery. If possible, stay in the hospital for 7-10 days after surgery. Do not rush to be discharged, because if problems arise after discharge, you and your child will not be returned to the maternity hospital. And you will have to lie without a child in the surgery department.

Here are just a small part of the reasons why sutures hurt after surgical childbirth. Only a doctor who examines and palpates the suture can determine the specific cause for your case. Trying to find the cause of pain on your own, with the help of virtual consultations with doctors, is futile.

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The suture hurts after surgery. The causes of pain can be different, including those not directly related to the suture. If the operation was performed in the abdominal cavity, then it is quite natural that the suture hurts after the operation, because, firstly, the sutures heal, and secondly, the tissues grow together. All these processes are accompanied by pain, but if their intensity increases and they become unbearable, then this indicates serious inflammation at the operation site; in this case, it is best not to take independent measures, but to seek help from a doctor. The suture hurts after appendicitis surgery. The pain of the postoperative suture in the area of ​​the lower corner of the subcutaneous scar after appendectomy may be the result of the fact that the elastic of the panties has rubbed, or a hernia or ligature abscess may form (the thread has not taken root). Between these conditions there are about a dozen other reasons. In addition, the treatment of these dozen diseases is completely different and individual. If you do not know how many days later the stitches are removed, then the pain caused by the stitches may last for a long time. Caring for postpartum sutures The doctor examines the genital tract after childbirth and applies internal or external sutures if necessary. The internal sutures practically heal without pain, but the external sutures hurt after childbirth for 1-2 months. Abdominal pain in women after childbirth if surgery has been performed. Sutures after cesarean section have a number of aspects that we will not dwell on now. If during childbirth a woman had an episiotomy, and there were ruptures in the tissues that required surgical intervention, then, of course, the sutures will hurt (as after any operation), most often the pain, of course, is concentrated in the perineum, but it can also radiate in the stomach, especially its lower part. The sutures gradually fuse together, and the pain goes away on its own. If a woman has a stomach ache after a cesarean section, then it is necessary to follow the hygiene rules prescribed by the doctor, avoid strain, monitor the condition of the suture, after a while the suture will heal and the pain will go away. Why do stitches hurt after childbirth? Many women are concerned about this issue within a month after childbirth. We will give several recommendations to alleviate the condition and reduce pain: Painful sensations make themselves felt constantly if you have to sit down or lift weights often - limit the weight of the objects you lift if possible and try not to sit on both buttocks; The stitches hurt after surgery on the perineum, if you suffer from constipation. In the first month after childbirth, a woman’s body is reconstructed, lactation requires the consumption of more fluid, and there is not enough fluid for normal bowel movements. A nursing mother should drink more warm milk, green tea, juice or herbal infusion. Read more about constipation after childbirth. Sometimes the stitches hurt after childbirth during sexual intercourse due to vaginal dryness and natural stress on the perineum. In this case, doctors recommend using a moisturizing gel. Sometimes changing the position to a non-painful one reduces pain. The sutures hurt and pull after childbirth due to tissue inflammation, then redness and purulent discharge appear. In this case, consult a gynecologist, but under no circumstances self-medicate. The sutures after childbirth hurt, as postpartum discharge forms a breeding ground for the proliferation of microbes that cause inflammation. On forums for young mothers, reviews about childbirth contain many questions: why do the stitches hurt after childbirth; how to care for stitches; what to do if the seams come apart? Only a gynecologist can give an answer in each specific case, who will conduct an examination and prescribe treatment if necessary. Stitches hurt after childbirth: what to do and why do they hurt? Oncology Surgical removal of cancerous tumors in the abdominal cavity, including malignant neoplasms in the kidneys, liver, bladder, and intestines. Oncological operations are always a complex and responsible process. After them, the patient is always tormented by pain in this area, in addition, after such operations a course of chemotherapy is still carried out, all this together leads to severe pain in the abdominal area. The suture hurts after a mastectomy. The area around the suture will still hurt for some time - this is normal, do not be afraid of it. There, sensitivity is restored after surgery. A skin bump is a so-called tuck, as if you sew up a hole in clothing; over time, it decreases.