Postoperative pain management. Organization and clinical experience

  • G. Galimberti
  • S. Nadalin
  • E. Corsi
Conference paper


Recent surveys show that a consistent portion of patients still receive inadequate treatment for postoperative pain despite major advances in the treatment of acute pain in the past decade. Undoubtedly, in some centres, due to either patient-controlled analgesia (PCA) or epidural analgesia, some patients have enjoyed a better quality of postoperative pain relief than the majority. However, it was not until 1988 in the United States that both these advanced techniques of pain management gained widespread use in the management of postoperative pain under the supervision of a dedicated team. PCA, epidural analgesia, and peripheral nerve blocks must be introduced on a routine basis because they provide superior analgesia compared with intromuscular (i.m.) opioids, but have their own risks and thus, require special monitoring. It is now generally accepted that postoperative pain can be managed more effectively by following established minimal standards under the responsibility of the anaesthesiology based Acute Pain Services (APS). The success of acute pain teams — it is now a condition for accreditation that an acute hospital has an acute pain team — has resulted in extension of the roles outside the treatment of postsurgical pain into roles in the medical wards, intensive care units, neurosurgical intensive care units, and emergency departments. While better postoperative pain management is relatively easy to obtain, there has to be a balance between acceptable risk, proven benefit — the growth of evidence-based medicine — and cost-effectiveness. Published guidelines underline the importance of treating effectively postoperative pain in any patient undergoing surgery, even if cost issues in pain management have been poorly studied.


Postoperative Pain Pain Management Epidural Analgesia Acute Pain Postoperative Pain Relief 
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  1. 1.
    Cohen FL (1980) Postsurgical pain relief: patients’status and nurses’ medication choices. Pain 9: 265–274PubMedCrossRefGoogle Scholar
  2. 2.
    Maier C, Raetzel M, Wulf H (1994) Audit in 1989 and 1994 of the Department of Anaesthesiology and Intensive Care, Hospital of Christian -Albrechts-University, Schwanenweg 21, D 24105, Kiel, GermanyGoogle Scholar
  3. 3.
    Neugebauer E, Hempel K, Sauerland S et al (1998) The status of perioperative pain therapy in Germany. Results of a representative, anonymous survey of 1000 surgical clinics. Chirurg 69: 461–466PubMedCrossRefGoogle Scholar
  4. 4.
    Donovan M, Dillon P, McGuire L (1983) Incidence and characteristics of pain in a sample of medical-surgical inpatients. Pain 30:69–78CrossRefGoogle Scholar
  5. 5.
    Kuhn S, Cooke K, Collins M et al (1990) Perceptions of pain relief after surgery. B M J 300: 1687–1690PubMedCrossRefGoogle Scholar
  6. 6.
    Owen H, McMillan V, Rogowski D (1990) Postoperative pain therapy: a survey of patients’ expectations and their experiences. Pain 41: 303–307PubMedCrossRefGoogle Scholar
  7. 7.
    Rawal N, (1994) Organization of Acute Pain Services. Pain 57:117–123PubMedCrossRefGoogle Scholar
  8. 8.
    Smith G (1991) Pain after surgery (editorial). Br J Anaesth 67:232–233Google Scholar
  9. 9.
    Rawal N (1996) Organization of postoperative pain service. In: Gullo A (ed) Anaesthesia pain intensive care and emergency medicine. Springer-Verlag Italia, Milan, pp 835–840Google Scholar
  10. 10.
    Weis OF, Sriwatanakul K, Alloza JL et al (1983) Attitudes of patients, housestaff, and nurses toward postoperative analgesic care. Anesth Analg 2:70–74Google Scholar
  11. 11.
    Watson A, Allen PR (1994) Influence of thoracic epidural analgesia on outcome after resection for esophageal cancer. Surgery 115:421–432Google Scholar
  12. 12.
    Yeager MP, Glass DD, Neff RK et al (1987) Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology 66:729–736PubMedCrossRefGoogle Scholar
  13. 13.
    Rawal N (1999) Organization of acute pain services. In: Gullo A (ed). Regional anaesthesia, analgesia and pain management. Springer-Verlag Italia, Milan, pp 227–234CrossRefGoogle Scholar
  14. 14.
    Liu S, Carpenter RL, Neal JM (1995) Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology 82:1474–1506PubMedCrossRefGoogle Scholar
  15. 15.
    Kehlet H (1995). Synergism between analgesic. Ann Med 27:25945CrossRefGoogle Scholar
  16. 16.
    Harrison CA, Morris S, Harvey JS (1994) Effect of ihoinguinal and iliohypogastric nerve block adn wound infiltration with 0.5% bupivacaine on postoperative pain after hernia repair. Br J Anaesth 72:691–693PubMedCrossRefGoogle Scholar
  17. 17.
    White PF (1985) Patient-controlled analgesia: a new approach to the management of postoperative pain. Semin Anesth 4:255–266Google Scholar
  18. 18.
    Ballantyne JC, Carr DB, Chalmers TC et al (1993) Postoperative patient-controlled analgesia: meta-analyses of initial randomized controlled trials. J Clin Anesth 5:182–193PubMedCrossRefGoogle Scholar
  19. 19.
    Schug SA, Torrie JJ (1993) Safety assessment of postoperative pain management by an acute pain service. Pain 55:387–391PubMedCrossRefGoogle Scholar
  20. 20.
    Etches RC (1994) Respiratory depression associated with patient-controlled analgesia: a review of eight cases. Can J Anaesth 41:125–132PubMedCrossRefGoogle Scholar
  21. 21.
    Parker RK, Holtmann B, Smith I etal (1988) Use of ketorolac after lower abdominal surgery. Effect on analgesic requirement and surgical outcome. Anesthesiology 80:6–12CrossRefGoogle Scholar
  22. 22.
    Eisenach JC, Grice SC, Dewan DM (1988) Patient-controlled analgesia following cesarean section: a comparison with epidural and intramuscular narcotics. Anesthesiology 68:444–448PubMedCrossRefGoogle Scholar
  23. 23.
    Yeager MP, Glass DD, Neff RK et al (1987) Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology 66:729–736PubMedCrossRefGoogle Scholar
  24. 24.
    Tuman KJ, McCarthy RJ, March RJ et al (1991) Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesth Analg 73:696–704PubMedCrossRefGoogle Scholar
  25. 25.
    Scott J, Huskisson EC (1976) Graphic representation of pain. Pain 2:175–184PubMedCrossRefGoogle Scholar
  26. 26.
    Gaston-Johansson F, Gustafsson M (1990) Rheumatoid arthritis: determination of pain charar- cteristics and comparison of RAI and VAS in its measurement. Pain 41:35–40PubMedCrossRefGoogle Scholar
  27. 27.
    Jensen MP, McFarland CA (1993) Increasing the rehability and validity of pain intensity measurement in chronic pain patients. Pain 55:195–203PubMedCrossRefGoogle Scholar
  28. 28.
    Joyce CRB, Autshi DW, Mason RM (1975) Comparison of fixed interval and visual analog scales for rating chronic pain. Eur J Clin Pharmacol 8:415–420PubMedCrossRefGoogle Scholar
  29. 29.
    Ohnhaus EE, Adler R (1975) Methodological problems in the measurement of pain: a comparison between the verbal rating scale and the visual analog scale. Pain 1:379–384PubMedCrossRefGoogle Scholar
  30. 30.
    Carlsson AM (1983) Assessment of chronic pain. Aspects of the reliabihty and validity of the visual analog scale. Pain 16:87–101PubMedCrossRefGoogle Scholar
  31. 31.
    DeLoach LJ, Higgins MS, Caplan AB et al (1998) The visual analog scale in the immedaite postoperative period: intrasubject variability and correlation with a numeric scale. Anesth Analg 86:102–106PubMedGoogle Scholar
  32. 32.
    Liu S, Carpenter RL, Neal JM (1995) Epidural anesthesia and analgesia. Anesthesiology 82: 1474–1506PubMedCrossRefGoogle Scholar
  33. 33.
    Rawal N, Axelsson K, Hylander J et al (1998) Postoperative patient-controlled local anesthetic administration at home. Anesth Analg 86:86–89PubMedGoogle Scholar
  34. 34.
    American Society of Anesthesiologists Task Force on Pain Management, Acute Pain Section (1995) A practical guidelines for acute pain managements in the perioperative setting. Anesthesiology 82:1071–1081CrossRefGoogle Scholar
  35. 35.
    Max MB, Donovan M, Portenoy RK (1991) American Pain Society Quahty Assurance Standards for Relief of Acute Pain and Cancer Pain, Committee on Quality Assurance Standanrds, American Pain Society, In: Bond MR, Charlton JE, Woolf GJ (ed) Proceedings of the Vlth Worid Congress on Pain. Elsevier, New York, pp 185–189Google Scholar
  36. 36.
    Ready LB, Edwards WT (1992) Management of acute pain. A practical guide, task force on acute pain, international associate for the study of pain. IASP, SeattleGoogle Scholar
  37. 37.
    Maier C, Kibbel K, Mercker S etal (1994) Postoperative pain therapy at general nursing stations. An analysis of eight years of experience at an anesthesiological acute pain service. Anaesthesist 43:385–397PubMedCrossRefGoogle Scholar
  38. 38.
    Ready BL, Oden R, Chadwick HS et al (1988) Development of an anesthesiology-based postoperative pain management service. Anesthesiology 68:100–106PubMedCrossRefGoogle Scholar
  39. 39.
    Burstal R, Wegener F, Hayes C (1988) Epidural analgesia: prospective audit of 1062 patients. Anaesth Intensive Care 26:165–172Google Scholar
  40. 40.
    The Royal College of Surgeons of England and The College of Anaesthesists (1990) Commission on the Provision of Surgical Services. Report of the Working Party on Pain after surgery. HMSO, LondonGoogle Scholar
  41. 41.
    Windsor AM, Glynn CJ, Mason DG (1996) National provision of acute pain services. Anaesthesia 51:228–231PubMedCrossRefGoogle Scholar
  42. 42.
    Stacey BR, Rudy TE, Nelhaus D (1997) Management of patient-controlled analgesia: a comparison of primary surgeons and dedicated pain service. Anesth Analg 85:130–134PubMedGoogle Scholar
  43. 43.
    Saidman LJ (1988) The anesthesiologist outside the operating room: a new and exciting opportunity (editorial). Anesthesiology 68:100–106CrossRefGoogle Scholar
  44. 44.
    Sartain JB, Barry JJ (1999) The impact of an acute pain service on postoperative pain management. Anaesth Intensive Care 27:375–380PubMedGoogle Scholar
  45. 45.
    Macintyre PE, Runciman WB, Webb R (1990) An acute pain service in an Australian teaching hospital: the first year. Med J Aust 153:417–421PubMedGoogle Scholar
  46. 46.
    Murphy DF, Graziotti P, Chalkiadis G et al (1994) Patient-controlled analgesia: a comparison with nurse-controlled intravenous opioid infusions. Anaesth Intensive Care 22:589–592PubMedGoogle Scholar
  47. 47.
    Casasola OA de leon, Parker BM, Lema MJ etal (1994) Epidural analgesia versus intravenous patient-controlled analgesia. Differences in the post-operative course of cancer patients. Reg Anesth 19:307–315Google Scholar

Copyright information

© Springer-Verlag Italia 2003

Authors and Affiliations

  • G. Galimberti
  • S. Nadalin
  • E. Corsi

There are no affiliations available

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