Acute Post-Surgical Pain Management: A Critical Appraisal of Current Practice

Abstract

The Acute Pain Summit 2005 was convened to critically examine the perceptions of physicians about current methods used to control postoperative pain and to compare those perceptions with the available scientific evidence. Clinicians with expertise in treatment of postsurgical pain were asked to evaluate 10 practice-based statements. The statements were written to reflect areas within the field of acute-pain management, where significant questions remain regarding everyday practice. Each statement made a specific claim about the usefulness of a specific therapy (eg, PCA or epidural analgesia) or the use of pain-control modalities in specific patient populations (eg, epidural analgesia after colon resection). Members of the American Society of Regional Anesthesia and Pain Medicine (ASRA) were asked, via a Web-based survey, to rate their degree of agreement with each of the 10 statements; 22.8% (n = 632) of members responded. In preparation for the pain summit, a panel member independently conducted a literature search and summarized the available evidence relevant to each statement. Summit participants convened in December 2005. The assigned panel member presented the available evidence, and workshop participants then assigned a category for the level of evidence and recommendation for each statement. All participants then voted about each statement by use of the same accept/reject scale used earlier by ASRA members. This manuscript details those opinions and presents a critical analysis of the existing evidence supporting new and emerging techniques used to control postsurgical pain.

Continuous epidural infusion of morphine versus single epidural injection of extended-release morphine for postoperative pain control after arthroplasty: a retrospective analysis

“…[10][11][12] Because of the risk of respiratory depression, the continuous monitoring of vital signs is recommended for all patients who receive extended-release epidural morphine. [23][24][25] The current results support this recommendation.…”

Pain on the first postoperative day after head and neck cancer surgery

“…For adults it is known that appropriate management of postoperative pain reduces perioperative morbidity, complications, hospital stay, and costs [1]. In general we know for adults that there seems to be a worldwide undersupply with adequate pain management after surgery [2,3]. Recently, a prospective cohort study using data of 70,764 patients taking part in the Quality Improvement in Postoperative Pain Treatment (QUIPS) registry has shown that postoperative pain on the first postoperative day is high in spite of perioperative pain management in many major thoracic and abdominal surgeries often performed for malignant diseases [4].…”

Postoperative analgesia by non-specialists in pain

“…Other numbers represent intermediate pain stages. Pain was classified as absent (0), mild (1-3), moderate (4-6) and severe (7)(8)(9)(10) 17 . The model with multinomial response and logistic binding function was used for statistical analysis, where variables "type of surgery" and "type of drugs used" were correlated with possible effects on pain intensity 12 and 24 hours after surgery.…”

“…Notwithstanding the increasing number of hospitals offering pain services, there are still places where it is not available, making postoperative analgesic prescription responsibility of the assistant physician 7 . The importance of treating acute postoperative pain is that, in addition to being an unpleasant feeling to patients, it is a risk factor to the development of chronic pain and to increase morbidity 10 . Pain persistence is associated to organic disorders, such as hypoventilation, increased heart work, decreased peripheral blood perfusion and reflex muscle contraction 11 .…”