Postoperative Pain Management

Abstract

Postoperative pain remains a significant problem for patients undergoing ambulatory and in-house surgery and is frequently undermanaged. Ineffective pain control can result in negative outcomes such as prolonged rehabilitation, delayed wound healing, cardiovascular complications, and development of chronic pain. Consequently, physicians involved in postoperative pain management should develop individualized strategies based on patient characteristics and surgical procedures. Ideally, a specific plan for postoperative pain management is developed prior to surgery and includes the patient and physician and caregivers from several medical disciplines. A multimodal approach utilizes agents from different drug classes and various techniques and allows targeting different receptors and pain pathways. In addition, such an approach avoids side effects frequently associated with monotherapy. Over the last decade, regional anesthesia techniques and especially peripheral nerve blocks have emerged as an important component of such a multimodal approach. The ability of peripheral nerve blocks to provide effective and tailored pain control in combination with a favorable side-effect profile has resulted in outcome improvements, especially after major orthopedic surgery. This chapter will review the different tools available to the pain management physician and his team and illustrate their individual strengths and indications.