Postoperative Analgesia

Article information

J Korean Med Assoc. 2007;50(12):1090-1095

Publication date (electronic) : 2007 December 31

doi : https://doi.org/10.5124/jkma.2007.50.12.1090

Department of Anesthesiology, Seoul National University College of Medicine, Korea. bahkjh@plaza.snu.ac.kr

Abstract

Uncontrolled or inadequately controlled postoperative pain may lead to delayed recovery from surgery, pulmonary complications, and restriction of mobility leading to increased risk of thromboembolism. Standardized regimens for pain management can lead to safer and better pain control. Of these regimens, patient-controlled analgesia, a delivery system with which patients self-administer small, predetermined analgesic doses, produced improved pain relief, greater patient satisfaction, less sedation, and fewer postoperative complications. Anesthesiologists have played an important role to make this pain management feasible. The introduction of acute pain services at hospitals prompted improvements in postoperative pain management in addition to the minimization of related complications.

Keywords: Postoperative pain; Standardized analgesic regimen; Patient-controlled analgesia; Acute pain service

References

1. Reuben SS, Buvanendrain A. Preventing the development of chronic pain after orthopaedic surgery with preventive multimodal analgesic techniques. J Bone Joint Surg Am 2007. 891343–1358.

2. Waldman SD. Pain Management 2007. 1st edth ed. Philadelphia: Saunders; 200.

3. The Korean Pain Society. Pain Medicine 2007. 3rd edth ed. Seoul: Koonja Publishing; 33–50.

4. Benzon HT, Raja SN, Molloy RE, Liu SS, Fishman SM. Essentials of Pain Medicine and Regional Anesthesia 2005. 2nd edth ed. Philadelphia: Elsevier; 29–34.

5. Buvanendran A, Reuben SS, Kroin JS. Recent advances in nonopioid analgesics for acute pain management. Tech Reg Anesth Pain Med 2007. 1119–26.

6. Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine. Acute pain management: scientific evidence 2005. 2nd edth ed. http://www.anzca.edu.au/resources/books-and-publlications.

7. Remy C, Marret E, Bonnet F. State of the art of paracetamol in acute pain therapy. Curr Opin Anaesthesiol 2006. 19562–565.

8. Bollish SJ, Colllins CL, Kirking DM, Bartlett RH. Efficacy of patient-controlled versus conventional analgesia for postoperative pain. Clin Pham 1985. 448–52.

9. Walder B, Schafer M, Henzi I, Tramèr MR. Efficacy and safety of patient-controlled opioid analgesia for acute postoperative pain: a quantitative systemic review. Acta Anaesthesiol Scand 2001. 45795–804.

10. Culebras X, Corpataux JB, Gaggero G, Tramèr MR. The antiemetic efficiency of droperidol added to morphine patient-controlled analgesia: a randomized, controlled, multicenter dose-finding study. Anesth Analg 2003. 97816–821.

11. Gan TJ, Meyer T, Apfel CC, Chung F, Davis PJ, Eubanks S, Kovac A, Philip BK, Sessler DI, Temo J, Tramèr MR, Watcha M. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 2003. 9762–71.

12. Momeni M, Crucitti M, De Kock M. Patient-Controlled Analgesia in the Management of Postoperative Pain. Drugs 2006. 662321–2337.

13. Lynch EP, Lazor MA, Gellis JE, Orav J, Goldman L, Marcantonio ER. The impact of postoperative pain on the development of postoperative delirium. Anesth Analg 1998. 86781–785.

14. Dolin SJ, Cashman JN. Tolerability of acute postoperative pain management: Nausea, vomiting, sedation, pruritus, and urinary retention. Evidence from published data. Br J Anaesth 2005. 95584–591.

15. Lim YJ, Bahk JH, Ahn WS, Lee SC. Coiling of lumbar epidural catheters. Acta Anaesthesiol Scand 2002. 46603–606.

16. Ryu HG, Bahk JH, Lee CJ, Lim YJ. The coiling length of thoracic epidural catheters: the influence of epidural approach angle. Br J Anaesth 2007. 98401–404.

Article information Continued

Figure 1

Visual Analogue Scale (VAS), Numerical Rating Scale (NRS) and Verbal Rating Scale (VRS) (2).

Table 1

Suggested steps to improve postoperative analgesia(6)

Adult doses given; adjust for weight and age in children. NSAIDs=non-steroidal anti-inflammatory drugs, COX-2=cyclo-oxygenase 2. Special populations: chronic pain patients and those on chronic opioid or opioid antagonist therapy (eg, oxycodone, morphine, methadone, naltrexone, and transdermal buprenorphine and fentanyl) require particularly individualized attention that includes preoperative planning of appropriate analgesic regimen and close supervision from acute pain service (or equivalent).

Table 2

Comparison between patient-controlled analgesia (PCA) and nurse-controlled analgesia (NCA) (12)

= indicates equal; > indicates superior; < indicates inferior