Pain management

Pain management is now a priority: it must be carried out throughout the patient's journey and has only one goal: that the patient never feels pain. This has become possible thanks to advances in: - anesthesia: locoregional anesthesia, whose effects are prolonged for 24 hours after the operation, ensures the absence of pain by putting the foot to sleep. - surgery: minimally invasive surgery is much less aggressive on the tissues and therefore less painful. This pain management is done in several stages
Post-operative pain management

 Which consists in making a constant analysis of our activity in relation to the available professional recommendations, resulting in the implementation of tools and methods for improving professional practices, the involvement of practitioners in the various quality and efficiency indicators in the partner structures.

 

At the clinic:

It is based on the indolence brought on by the local anesthesia, the effects of which are prolonged for 12 to 24 hours after the procedure, giving the patient a feeling of sleepiness of the foot, interrupting the pain process. The foot wakes up very gradually, allowing the patient to take over pain medication at home.

 

Back home:

Fighting postoperative pain:

Once the patient has left the clinic, the relay is taken with an intravenous device, allowing a slow and progressive diffusion of the analgesic products, thus preventing any installation of pain. (No morphine is used to avoid intolerance).
Until recently, this intravenous analgesia implied a hospitalization to allow the use of an electric syringe, a specific and bulky material. Thanks to the analgesic diffuser (a single-use, miniaturized device) and a specialized network of private nurses trained in the use of this equipment, this analgesia can be performed on an outpatient basis for the greater comfort of the patient who prefers
- Sleeping and eating at home
- Avoiding noise pollution in a health care facility
- To be surrounded by loved ones

The analgesic diffuser is a disposable material made up of a bottle and a tube that allows the analgesic to diffuse.

Thanks to a network of liberal nurses trained in the use of this equipment, the diffuser is recharged once a day and the level of analgesia is checked (EVA scale).

The analgesic diffuser thus constitutes a significant technical advance in the interest of the patient.

When the intravenous device is stopped, an oral analgesic is taken for 4 to 7 days. It is recommended to take the latter regularly (1 tablet with each meal) and systematically. Beyond this period, the treatment will depend on your feelings.
These three anti-pain treatments (loco-regional anaesthesia, intravenous analgesic diffuser, oral analgesics) are based on a fundamental anti-pain principle: the treatment must always be taken before the onset of pain in order to anticipate it and thus allow good analgesia.

 

Fight against postoperative edema:

The patient must be made aware that the treatments
painkillers are meaningless, as long as they do not
are not accompanied by a scrupulous respect of the instructions for the fight against post-operative oedema (oedema distends the tissues and can thus generate pain): its resorption will be favoured by :

1- Elevation of the lower limb in the lying and sitting positions: it facilitates venous return and thus favors the disappearance of the edema. As a guide, "the feet should be placed above the heart".

2 - the proper follow-up of the protocol for resuming support is also important in the treatment of pain. Indeed, the patient must know that any excessive resumption of this support in the four weeks following the operation is synonymous with oedema and therefore potential pain.
Thus, support must be limited to its strict minimum during the first week post-op, by staying at home. It is imperative to avoid standing and walking.
From the second week onwards, you will be able to walk outside again, but you will have to split your walking time: never more than a quarter of an hour at a time, and a total of 2 to 3 hours per day is allowed.
From the 3rd week on, gradually increase the walking according to your feeling.

3 - Re-education: Re-education and self-education, started early between D 15 and D 21 post-op, play a role in the treatment of pain thanks to the draining function of the edema that massage therapy and passive mobilization of the foot allow. A real manual lymphatic drainage is often also very useful.

4- Icing: associated with the raising of the lower limb, it has anti-inflammatory and anti-edematous virtues and therefore anti-pain.

Preoperative consultations (surgeon and anesthesiologist)

During these consultations, the surgeon as well as the anaesthetist will provide the most complete information possible in order to enlighten the patient on the different stages of pain management

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