title: Peri-operative pain and its consequences.
abstract: Recent advances in the management of peri-operative pain principally concern the recognition of the risk of developing pain chronicity. The best identified risk factors for pain chronicity are the presence of pain pre-operatively, pre-operative opioid use, and the intensity of post-operative pain. Ideal management of peri-operative pain in 2015 aims to optimize post-operative pain management, to detect the risk of pain chronicity begins pre-operatively with early detection of risk factors for chronicity. In terms of treatment, the systematic and generous use of morphine has shown its limitations, particularly due to reduced efficacy for movement-related pain. Meanwhile, opioid side effects can be very debilitating for the patient, leading to delay in post-operative rehabilitation, a dose-dependent hyperalgesic effect resulting in both acute and chronic pain, immune modulation that may have a deleterious impact on infectious complications or cancer [1], and, finally, some question of possible neurotoxicity. Therefore, modern analgesia depends on both intra-operative and post-operative morphine sparing. The goal at the present time is to obtain optimal analgesia that allows rapid rehabilitation without sequelae or chronicity through the use of drugs and/or techniques to avoid the need for opioid medications.
authors: Pôle Anesthésie et Réanimation, CHU Rennes, 35033 Rennes, France; Inserm UMR 991, Université Rennes 1, 35033 Rennes, France. Electronic address: helene.beloeil@chu-rennes.fr.
authors: H
authors: H
authors: Beloeil
authors: Inserm UMR 991, Université Rennes 1, 35033 Rennes, France; Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, 35033 Rennes, France.
authors: L
authors: L
authors: Sulpice
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D059350:Chronic Pain / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009021:Morphine Dependence / Q000209:etiology / Q000517:prevention & control; D009293:Opioid-Related Disorders / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D061214:Patient Safety; D019990:Perioperative Care / Q000379:methods; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid
keywords: Morphine sparing; Peri-operative pain; Post-surgical chronic pain