Although traditional methods of administering postoperative analgesia may be inadequate, they do have the merit of simplicity and familiarity carries a degree of inherent safety. Of the newer techniques which have been introduced, perhaps patient-controlled analgesia has the greatest degree of inherent safety but mishaps may arise as a result of programming error or machine failure. Extradural techniques employing either local analgesic agents or opioids require enhanced patient monitoring.
For many years, advanced techniques of analgesia have been employed safely by retaining patients in intensive care units or, in many European centres, in high dependency nursing areas for 24–48 hours after surgery. The ability to finance time spent in treating patients in surgical wards postoperatively has recently enabled Ready and his colleagues to develop and operate an acute pain team to supervise patient-controlled analgesia and extradural opioid analgesia on normal surgical wards26. This work may help to identify those groups of patients who may be treated safely with advanced analgesic techniques on the normal wards and those who require high dependency nursing units.
Smith G. Postoperative Pain in Anaesthesia. W. S. Nimmo, and G. Smith (Eds.). Blackwell Scientific Publications, 1989.
Parbrook GD, Steel DF, Dalrymple DG. Factors predisposing to postoperative pain and pulmonary complications. A study of male patients undergoing elective gastric surgery. Br J Anaesth 1973; 45: 21–33.
Bond MR. Psychological and psychiatric aspects of pain. Anaesthesia 1978; 33: 355–61.
Ulert IA. Narcotics in the postoperative period: a reappraisal. South Med J 1967; 60: 1289–94.
Singh PN, Sharma P, Gupta PK, Pandey K. Clinical evaluation of diazepam for relief of postoperative pain. Br J Anaesth 1981; 53: 831–6.
Austin KL, Stapleton JV, Mather LE. Multiple intramuscular injections: a major source of variability in analgesic response to meperidine. Pain 1980; 8: 47–62.
Tamsen A, Hartvig P, Dahlstrom B, Lindstrom B, Holmdahl M. Patient controlled analgesic therapy in the early postoperative period. Acta Anaesthesiol Scand 1979; 23: 462–70.
White WD, Pearce DJ, Norman J. Postoperative analgesia: a comparison of intravenous on-demand fentanyl with epidural bupivacaine. 1979; Br Med J 1979; 2: 166–7.
Bennett R, Batenhurst R, Graves DA, Foster TS, Griffen WO, Wright BD. Variation in postoperative analgesic requirement in the morbidly obese following gastric bypass surgery. Pharmacotherapy 1982; 2: 50–3.
Lim AT, Edis G, Kranz H, Mendelson G, Selwood T, Scott DF. Postoperative pain control: contribution of psychological factors and transcutaneous electrical stimulation. Pain 1983; 17: 179–88.
Tamsen A, Sakurada T, Wahlstrom A, Terenius L, Hartvig P. Postoperative demands for analgesics in relation to individual levels of endorphins and substance P in cerebrospinal fluid. Pain 1982; 13: 171–83.
Ellis R, Haines D, Shah R, Cotton BR, Smith G. Pain relief after abdominal surgery —a comparison of intramuscular morphine, sublingual buprenorphine and self-administered intravenous pethidine. Br J Anaesth 1982; 54: 421–8.
Rutter PC, Murphy F, Dudley HAF. Morphine: controlled trial of different methods of administration for postoperative pain relief. Br Med J 1980; 1: 12–3.
Saha SK. Continuous infusion of papaveretum for relief of postoperative pain. Postgraduate Medical Journal 1981; 57: 686–9.
Catling JA, Pinto DM, Jordon C, Jones JG. Respiratory effects of analgesia after cholecystectomy: comparison of continuous and intermittent papaveretum. Br Med J 1980; 281: 478.
Sechzer PH. Studies in pain with the analgesic-demand system. Anaesthesia 1971; 50: 1–10.
White PF. Mishaps with patient-controlled analgesia. Anesthesiology 1987; 66: 81–3.
Vickers AP, Derbyshire DR, Bun DR, Bagshaw PF, Pearson H, Smith G. Comparison of the Leicester Micropalliator and the Cardiff Palliator in the relief of postoperative pain. Br J Anaesth 1987; 59: 503–9.
Hanning CD, Vickers AP, Smith G, Graham NB, McNeil ME. The morphine hydrogel suppository. A new sustained release preparation. Br J Anaesth 1988; 61: 221–8.
Holley FO, Van Steennis C. Postoperative analgesia with fentanyl: pharmacokinetics and pharmacodynamics of constant-rate IV and transdermal delivery. Br J Anaesth 1988; 60: 608–13.
Rowbotham DJ, Wyld R, Peacock JE, Duthie DJR, Nimmo WJ. Transdermal fentanyl for the relief of pain after upper abdominal surgery. Br J Anaesth. 1989 (In press)
Buckley FP. Somatic nerve block for postoperative analgesia.In: Acute Pain. Smith G., Covino B.G., (Eds). Butterworths, London 1985; 205–27.
Stanton-Hicks MJ. Subarachnoid and extradural analgesic techniques.In: Acute Pain. Smith G., Covino B.G., (Eds.). Butterworths, London 1985; 228–56.
Lee A, Simpson D, Whitfield A, Scott DB. Postoperative analgesia by continuous extradural infusion of bupivacaine and diamorphine. Br J Anaesth 1988; 60: 845–50.
Chapman CR. Psychological Factors in Acute and Chronic Pain.In Anaesthesia. Nimmo W.S., Smith G. (Eds.). 1989. Blackwell Scientific Publications.
Ready LB, Oden R, Chadwick HS et al. Development of an Anesthesiology-based Postoperative Pain Management Service. Anesthesiology 1988; 68: 100–6.
About this article
Cite this article
Smith, G. Management of post-operative pain. Can J Anaesth 36, S1 (1989). https://doi.org/10.1007/BF03005318
- Postoperative Pain
- Postoperative Analgesia