Abstract
Recent surveys show that a large proportion of patients still receive in adequate post-surgical analgesia, this problem is international in character. Analgesia techniques such as patient-controlled analgesia (PCA), spinal opioids alone or in combination with local anaesthetics and other regional analgesia techniques provide superior pain relief as compared to intermittent i.m. injection of opioids. However, these techniques have their own risks and therefore require special monitoring. The first line of defence against serious complications is an organization that provides appropriate education and policies which allow nurses and physicians to safely care for patients. It is increasingly clear that the solution to the problems of postoperative pain management lies not so much in the development of new techniques but in the development of an organization to exploit existing expertise.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Gould TH, Crosby DL, Harmer M et al (1992) Policy for controlling pain after surgery: effect of sequential changes in management. Br Med J: 305: 1165–1166
Oates JDL, Snowden SL, Jayson DWH (1994) Failure of pain relief after surgery. Attitudes of ward staff and patients to postoperative analgesia. Anaesthesia: 49: 755–758
Warfield CA, Kahn CH (1995) Acute pain management. Programs in US hospitals and experiences and attitudes among US adults. Anesthesiology:83: 1090–1094
Tittle M, McMillan SC (1994) Pain and pain-related side effects in an ICU and on a surgical unit: nurses’ management. Am J Crit Care: 3: 25–30
Wulf H, Neugebauer E, Maier C (1997) Die Behandling akuter perioperativer und posttraumatischer Schmerzen. Empfuhlungen einer interdiszplinaeren Expertenkommission. G. Thieme, Stuttgart, New York.
Rawal N, Allvin R and the EuroPain Acute Pain Working Party. (1998) Acute pain service in Europe: a 17-nation survey of 105 hospitals. Eur J Anesth: 15: 354–363
Royal College of Surgeons of England and the College of Anaesthetists Commission on the Provision of Surgical Services. (1990) Report on the Working Party on Pain after Surgery. London, September.
National Health and Medical Research Council (Australia). (1998) Management of severe pain, Canberra, Australia.
U.S. Department of Health and Human Services. (1992) Acute pain management. Clinical practice guidelines. AHCPR Publications No 92-0032, USA.
International Association for the Study of Pain (IASP). (1992) Management of acute pain. A practical guide Task force on acute pain, IASP Publications. Seattle, USA.
Windsor AM, Glynn CJ, Mason DG (1996) National provision of acute pain services. Anaesthesia: 51: 228–231
Maier C, Kibbel K, Mercker S, Wulf H. (1994) Postoperative pain therapy at general nursing stations. An analysis of eight year’s experience at an anesthesiological acute pain service. Anaesthesist: 43: 385–397
Ready LB. (1995) How many acute pain services are there in the US and who is managing patient-controlled analgesia? (Letter). Anesthesiology: 82: 322
Kuhn S, Cooke K, Collins M et al (1990) Perceptions of pain relief after surgery. Br Med J: 300: 1687–1690
Rawal N, Berggren L (1994) Organization of acute pain services—a low cost model. Pain: 57: 117–123
Rawal N. (1999) 10 years of Acute Pain Services: achievements and challenges. Reg Anesth Pain Med; 24: 68–73
Harmer M, Davies KA (1998) The effect of education, assessment and a standardized prescription on postoperative pain management. Anaesthesia; 58: 424–30.
Papper EM, Brodie BB, Rovenstine EA (1952) Postoperative pain, its use in the comparative evaluation of analgesics. Surgery; 32: 107–109.
Ready LB. (1999) Acute pain, lessons learned from 25 000 patients. Reg Anesth Pain Med; 24: 499–505
Cousins MJ, Power I, Smith G. (2000) Pain—a persistent problem. Reg Anesth Pain Med; 25: 6–21
Andersen G, Rasmussen H, Rosenstock C et al (2000) Postoperative pain control by epidural analgesia after transabdominal surgery. Efficacy and problems encountered by daily routine. Acta Anaesthesiol Scand; 44: 296–301
Borgeat A, Schappi B, Biasca N, Gerber C (1997) Patient-controlled analgesia after major shoulder surgery: patient-controlled interscalene analgesia versus patient-controlled analgesia. Anesthesiology. Dec;87(6): 1343–13
Singelyn FJ, Deyaert M, Joris D et al (1998) Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg. Jul;87(l): 88–92
Horlocker TT. (1998) Peripheral nerve blocks—regional anesthesia for the new millennium [editorial]. Regional Anesthesia and Pain Medicine; 23(3): 237–40.
Capdevila X, Barthelet Y, Biboulet P et al (1999) Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. Jul;91(l): 8–15
Rawal N, Axelsson K, Hylander J et al (1998) Postoperative patient-controlled local anesthetic administration at home. Anesth Analg; 86: 86–89
Rawal N (2000) Patient controlled regional analgesia at home. Tech Reg Anesth Pain Mgmt; 4: 62–66
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2002 Springer-Verlag Italia
About this paper
Cite this paper
Rawal, N. (2002). The Challenge of Postoperative Analgesia. In: Gullo, A. (eds) Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-2099-3_81
Download citation
DOI: https://doi.org/10.1007/978-88-470-2099-3_81
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-0176-3
Online ISBN: 978-88-470-2099-3
eBook Packages: Springer Book Archive