Recent management advances in acute postoperative pain.
BACKGROUND
Acute postoperative pain remains a major problem, with both undertreatment and overtreatment leading to serious consequences, including increased risk of persistent postoperative pain, impaired rehabilitation, increased length of stay and/or hospital readmission, and adverse events related to excessive analgesic use, such as oversedation. New analgesic medications and techniques have been introduced that target the preoperative, intraoperative, and postoperative periods to better manage acute postoperative pain, with improvements in analgesic efficacy and safety over more traditional pain management approaches. This review provides an overview of these new analgesic medications and techniques. Specific topics that are discussed include the use of preoperative nonsteroidal anti-inflammatory drugs, anxiolytics, and anticonvulsants; intraoperative approaches such as neuraxial analgesia, continuous local anesthetic wound infusion, transversus abdominis plane block, extended-release epidural morphine, intravenous acetaminophen, and intravenous ketamine; and postoperative use of intravenous ibuprofen, new opioids (eg, tapentadol) or opioid formulations (morphine-oxycodone), and patient-controlled analgesia.


CONCLUSIONS
New, targeted, analgesic medications and techniques may provide a safer and more effective approach to the management of acute postoperative pain than traditional approaches such as postoperative oral analgesics.
Albany Medical College Neurology Group, Albany, New York, U.S.A.
Charles E
CE
Argoff
D059787:Acute Pain / Q000175:diagnosis* / Q000188:drug therapy*; D000700:Analgesics / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D006801:Humans; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods; D010149:Postoperative Pain / Q000175:diagnosis* / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic / Q000379:methods
D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal
acute pain; analgesia; intraoperative; perioperative; postoperative; preoperative; review