Analgesia technique and post-operative morbidity.
Good analgesia does not normalize post-operative pulmonary function but is important in allowing measures such as post-operative physiotherapy to be applied following major abdominal or thoracic surgery. Clinical studies have generally failed to duplicate animal work on the effectiveness of pre-emptive analgesia possibly because the nociceptor stimuli persist as long as there is wound pain. Anaesthetic techniques which include sensory blockade are associated with a lower incidence of several post-operative complications and this improvement is more marked in high-risk patients. The contributions of spinal opioids to this is not known. Long-lasting analgesia can be provided via a catheter inserted in a relevant neurovascular compartment. There is no evidence that multimodal 'balanced' analgesia offers any advantages in terms of improved outcome or reduction in adverse events. Whilst sophisticated methods for providing post-operative pain relief, such as PCA and PCEA, are highly effective, they are appropriate for only a minority of surgical operations. An Acute Pain Service can delivery a traditional intermittent opioid regime effectively at relatively low cost.
Rawal
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Department of Anesthesiology and Intensive Care, Orebro Medical Center Hospital, Sweden.
D000698:Analgesia / Q000191:economics / Q000379:methods*; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000758:Anesthesia; D006801:Humans; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control