Postoperative pain management in the postanesthesia care unit: an update

Abstract

Acute postoperative pain remains a major problem, resulting in multiple undesirable outcomes if inadequately controlled. Most surgical patients spend their immediate postoperative period in the postanesthesia care unit (PACU), where pain management, being unsatisfactory and requiring improvements, affects further recovery. Recent studies on postoperative pain management in the PACU were reviewed for the advances in assessments and treatments. More objective assessments of pain being independent of patients’ participation may be potentially appropriate in the PACU, including photoplethysmography-derived parameters, analgesia nociception index, skin conductance, and pupillometry, although further studies are needed to confirm their utilities. Multimodal analgesia with different analgesics and techniques has been widely used. With theoretical basis of preventing central sensitization, preventive analgesia is increasingly common. New opioids are being developed with minimization of adverse effects of traditional opioids. More intravenous nonopioid analgesics and adjuncts (such as dexmedetomidine and dexamethasone) are introduced for their opioid-sparing effects. Current evidence suggests that regional analgesic techniques are effective in the reduction of pain and stay in the PACU. Being available alternatives to epidural analgesia, perineural techniques and infiltrative techniques including wound infiltration, transversus abdominis plane block, local infiltration analgesia, and intraperitoneal administration have played a more important role for their effectiveness and safety.

Spinal Cord Stimulation for Acute Pain Following Surgery for Cervical Myelopathy: A Novel Treatment Strategy

“…Postoperative pain management has become an increasingly important concern in recent decades, and an array of postoperative medical regimens are effective to some degree . It has been demonstrated that adequate postoperative analgesia not only reduces the duration of hospital admission, but also enhances the benefit derived from undergoing surgery . Particularly in patients suffering from chronic pain, acute postsurgical pain management is often complex, partly due to alterations in central pain processing that hinder effective pharmacological therapy.…”

“…24,25 It has been demonstrated that adequate postoperative analgesia not only reduces the duration of hospital admission, but also enhances the benefit derived from undergoing surgery. 26,27 Particularly in patients suffering from chronic pain, acute postsurgical pain management is often complex, partly due to alterations in central pain processing that hinder effective pharmacological therapy. Owing to difficulties in managing acute postoperative pain, not least in the setting of a chronic pain syndrome, a variety of noninvasive and invasive techniques have been described, including local and regional anesthesiologic measures such as ilioinguinal nerve and hypogastric plexus blocks after herniorrhaphy and the use of intrapleural catheters after thoracic surgeries.…”

Relationship of Anxiety and Preoperative Depression With Post-Operative Pain

“…These conditions can result in persistent postoperative pain, prolonged duration of opioid use, delayed recovery time, longer hospitalization periods, and higher healthcare costs. [23][24] The tested multivariate model provided evidence that preoperative anxiety is a significant predictor of postoperative pain. In general, these data are consistent with the results found in recent studies regarding the perception of pain in the immediate postoperative period.…”

A Comparative study of epidural Fentanyl with Bupivacaine & epidural Tramadol with Bupivacaine for post operative pain relief after lower abdominal Surgery

“…It is important to understand that severe pain may not only be responsible for secondary complications like hemodynamic instability, atelectasis (due to restricted respiratory movements) but also it may be responsible for delayed recovery, prolonged hospital stay, late ambulation and increased morbidity [3] . Adequate analgesia is associated with significant reduction in perioperative cardiac morbidity, pneumonitis, pulmonary embolism, ileus, acute renal failure, and hemorrhagic shock [4] . Providing pain relief with on-demand opioid injections has largely been replaced by epidural analgesia using various agents like Tramadol and fentanyl [5] .…”