Postoperative pain management

H. W. Hopf and S. Weitz
Department of Anesthesia, University of California, San Francisco.

OBJECTIVES: To examine the relationship between analgesia and clinical outcome and to review new methods of delivering opioid analgesics and new pharmacologic analgesic agents. DATA SOURCES: A computer-assisted search of the literature on postoperative pain management, and a review of those areas in which new approaches have led to a change in clinical practice. RESULTS: Current research focuses on the ability of analgesia to decrease perioperative complications. Recent advances allow enhanced postoperative analgesia with a low incidence of side effects. Administration of opioids via a patient-controlled device or via an epidural catheter yields excellent analgesia with a low rate of side effects compared with intramuscular opioids. Several non-narcotic, parenteral drugs, including ketorolac tromethamine and alpha 2-adrenergic agonists are now available. These drugs decrease opioid requirement, and thus the rate of serious side effects, including respiratory depression. Moreover, because these drugs act at sites other than opioid receptors, they may enhance the quality of analgesia at the same time they decrease opioid requirement. CONCLUSIONS: New technology and new agents allow more rational management of postoperative pain. Use of these techniques results in increased patient satisfaction and may improve clinical outcome.