Postoperative Pain Management After Abdominal Surgery in a Surgical Intensive Care Unit A Retrospective Observational Study

Background: Postoperative pain following abdominal surgery remains a major concern in anesthesia and critical care practice. Inadequate pain control delays recovery, prolongs hospitalization, impairs respiratory function, and increases postoperative morbidity. Multimodal and individualized analgesic strategies are therefore essential for optimizing postoperative outcomes.Objective: This study aimed to evaluate the kinetics of postoperative pain during the first 48 hours after abdominal surgery and to identify the main determinants associated with pain intensity in patients admitted to a surgical intensive care unit.Methods: We conducted a retrospective, descriptive, and analytical study including 500 patients who underwent abdominal surgery at the Surgical Intensive Care Unit of the Ibn Rochd University Hospital between September 2024 and August 2025. Patients undergoing abdominal surgery either by laparotomy or laparoscopy and requiring hospitalization for at least 48 hours were included. Patients with communication difficulties or incomplete medical records were excluded. Pain intensity was assessed using the Visual Analog Scale (VAS) at awakening and during the first 48 postoperative hours.Results: A total of 500 patients were included, with a predominance of males (67.2%). The mean age was 45 years. Laparotomy accounted for 75% of procedures, whereas laparoscopy represented 25%. General anesthesia was performed in 87% of cases. Postoperative pain progressively decreased over the first 48 hours, with severe pain decreasing from 44.4% at awakening to 9.2% at H48. Simultaneously, the proportion of patients with well-controlled pain (VAS ≤ 3) increased from 16.8% to 71.2%. Laparoscopy was associated with significantly lower pain intensity compared with laparotomy. Similarly, patients without surgical drains experienced lower pain scores than those with drains. Multimodal analgesia based mainly on paracetamol and stepwise opioid escalation resulted in satisfactory but still improvable pain control.Conclusion: Postoperative pain after abdominal surgery remains frequent during the immediate postoperative period but shows favorable evolution under structured multimodal analgesia. Surgical approach, drain placement, and patient-related factors significantly influence postoperative pain intensity. Expanding locoregional anesthesia techniques and optimizing multimodal analgesic protocols could further improve postoperative recovery and opioid-sparing strategies.