Acute Postoperative Pain Management

Abstract

ffective postoperative pain control is an essential compo-nent of the care of the surgical patient. Inadequate paincontrol, apart from being inhumane, may result in in-creased morbidity or mortality (1, 2). Evidence suggests that sur-gery suppresses the immune system and that this suppression isproportionate to the invasiveness of the surgery (3, 4). Goodanalgesia can reduce this deleterious effect. Data available indi-cate that afferent neural blockade with local anesthetics is themost effective analgesic technique. Next in order of effectivenessare high-dose opioids, epidural opioids and clonidine, patient-controlled opioid therapy, and nonsteroidal anti-inflammatoryagents (5).The advantages of effective postoperative pain managementinclude patient comfort and therefore satisfaction, earlier mo-bilization, fewer pulmonary and cardiac complications, a reducedrisk of deep vein thrombosis, faster recovery with less likelihoodof the development of neuropathic pain, and reduced cost of care.The failure to provide good postoperative analgesia is multi-factorial. Insufficient education, fear of complications associatedwith analgesic drugs, poor pain assessment, and inadequate staff-ing are among its causes.