The Challenge of Postoperative Analgesia

  • N. Rawal
Conference paper


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.


Pain Management Postoperative Analgesia Visual Analogical Score Postoperative Pain Management Peripheral Nerve Block 


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  1. 1.
    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: 1165–1166CrossRefGoogle Scholar
  2. 2.
    Oates JDL, Snowden SL, Jayson DWH (1994) Failure of pain relief after surgery. Attitudes of ward staff and patients to postoperative analgesia. Anaesthesia: 49: 755–758PubMedCrossRefGoogle Scholar
  3. 3.
    Warfield CA, Kahn CH (1995) Acute pain management. Programs in US hospitals and experiences and attitudes among US adults. Anesthesiology:83: 1090–1094Google Scholar
  4. 4.
    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: 25–30PubMedGoogle Scholar
  5. 5.
    Wulf H, Neugebauer E, Maier C (1997) Die Behandling akuter perioperativer und posttraumatischer Schmerzen. Empfuhlungen einer interdiszplinaeren Expertenkommission. G. Thieme, Stuttgart, New York.Google Scholar
  6. 6.
    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: 354–363Google Scholar
  7. 7.
    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.Google Scholar
  8. 8.
    National Health and Medical Research Council (Australia). (1998) Management of severe pain, Canberra, Australia.Google Scholar
  9. 9.
    U.S. Department of Health and Human Services. (1992) Acute pain management. Clinical practice guidelines. AHCPR Publications No 92-0032, USA.Google Scholar
  10. 10.
    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.Google Scholar
  11. 11.
    Windsor AM, Glynn CJ, Mason DG (1996) National provision of acute pain services. Anaesthesia: 51: 228–231PubMedCrossRefGoogle Scholar
  12. 12.
    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: 385–397PubMedCrossRefGoogle Scholar
  13. 13.
    Ready LB. (1995) How many acute pain services are there in the US and who is managing patient-controlled analgesia? (Letter). Anesthesiology: 82: 322PubMedCrossRefGoogle Scholar
  14. 14.
    Kuhn S, Cooke K, Collins M et al (1990) Perceptions of pain relief after surgery. Br Med J: 300: 1687–1690CrossRefGoogle Scholar
  15. 15.
    Rawal N, Berggren L (1994) Organization of acute pain services—a low cost model. Pain: 57: 117–123PubMedCrossRefGoogle Scholar
  16. 16.
    Rawal N. (1999) 10 years of Acute Pain Services: achievements and challenges. Reg Anesth Pain Med; 24: 68–73PubMedGoogle Scholar
  17. 17.
    Harmer M, Davies KA (1998) The effect of education, assessment and a standardized prescription on postoperative pain management. Anaesthesia; 58: 424–30.CrossRefGoogle Scholar
  18. 18.
    Papper EM, Brodie BB, Rovenstine EA (1952) Postoperative pain, its use in the comparative evaluation of analgesics. Surgery; 32: 107–109.PubMedGoogle Scholar
  19. 19.
    Ready LB. (1999) Acute pain, lessons learned from 25 000 patients. Reg Anesth Pain Med; 24: 499–505PubMedGoogle Scholar
  20. 20.
    Cousins MJ, Power I, Smith G. (2000) Pain—a persistent problem. Reg Anesth Pain Med; 25: 6–21PubMedGoogle Scholar
  21. 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: 296–301PubMedCrossRefGoogle Scholar
  22. 22.
    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): 1343–13CrossRefGoogle Scholar
  23. 23.
    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): 88–92Google Scholar
  24. 24.
    Horlocker TT. (1998) Peripheral nerve blocks—regional anesthesia for the new millennium [editorial]. Regional Anesthesia and Pain Medicine; 23(3): 237–40.PubMedCrossRefGoogle Scholar
  25. 25.
    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): 8–15CrossRefGoogle Scholar
  26. 26.
    Rawal N, Axelsson K, Hylander J et al (1998) Postoperative patient-controlled local anesthetic administration at home. Anesth Analg; 86: 86–89PubMedGoogle Scholar
  27. 27.
    Rawal N (2000) Patient controlled regional analgesia at home. Tech Reg Anesth Pain Mgmt; 4: 62–66CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • N. Rawal
    • 1
  1. 1.Department of Anaesthesiology and Intensive CareÖrebro Medical Centre HospitalÖrebroSweden

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