An expert opinion on postoperative pain management, with special reference to new developments.
BACKGROUND
Recently, much attention has been directed towards the effect of opioid-sparing strategies on postoperative morbidity and hospitalization, and on different nociceptive mechanisms involved in various postoperative pain states and surgical procedures. This has resulted in an increased interest in secondary, or adjunct, analgesics and procedure-specific analgesic methods.


METHODS
The present paper aims to review and discuss recent developments within the field of various adjunct, systemic analgesics and local/regional anesthetic methods for management of postoperative pain, based on evidence from randomized, clinical trials published within the last 5 years.


RESULTS
The reader will gain insight into the current role of pregabalin, glucocorticoids and systemic lidocaine for the management of postoperative pain. In addition, the current status of local infiltration analgesia for hip and knee arthroplasty, transversus abdominis plane block for abdominal operations, and the analgesic effect of wound instillation of capsaicin are reviewed.


CONCLUSIONS
The evidence of a substantial analgesic effect of pregabalin on acute postoperative pain is questionable, and more convincing evidence of the role of glucocorticoids and systemic lidocaine is needed before they should be recommended as analgesics in daily clinical practice. Local infiltration analgesia after hip and knee arthroplasty, transversus abdominis plane block after abdominal operations and local application of capsaicin lend some promise, but there is still a lack of well-performed RCTs to draw any firm conclusions. Procedure-specific analgesic combinations within well-defined rehabilitation paradigms should be explored further to reduce adverse effects associated with the use of conventional analgesic treatment protocols, and to improve postoperative outcome.
Dahl
Jørgen B
JB
Copenhagen University, Centre of Head and Orthopaedics, Department of Anaesthesia, Denmark. jbdahl@dadlnet.dk
Mathiesen
Ole
O
Kehlet
Henrik
H
D000698:Analgesia / Q000379:methods / Q000639:trends*; D000700:Analgesics / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000818:Animals; D002211:Capsaicin / Q000008:administration & dosage; D019468:Disease Management; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control; D000069583:Pregabalin; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000639:trends; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage / Q000031:analogs & derivatives
D000700:Analgesics; D000701:Analgesics, Opioid; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D008012:Lidocaine; D002211:Capsaicin