Patient-Controlled Analgesia (Part I): Historical Perspective

Abstract

Despite advances in our understanding of the pathophysiology of acute postoperative pain and the pharmacology of analgesic drugs, postoperative pain is not always effectively treated. Since the early report on the under treatment of pain by Marks and Sachar (1), there are numerous publications describing inadequate management of postoperative pain (2,3). It is now recognized that under treatment of postoperative pain may be due to a number of factors related to knowledge, skills and attitudes of health care personnel, including concerns for side effects of analgesic drugs. In addition, the inherent pharmacokinetic and pharmacodynamic variability among patients contributes to differences in their analgesic requirements. Furthermore, variability in the patients’ perception of pain contributes to difficulty in determining the appropriate dose of analgesic drugs.

Adapted from Joshi GP, White PF. Patient-Controlled Analgesia (Chapter 35). In Management of Acute Pain (M Ashburn and LJ Rice, Editors), New York: Churchill Livingston, 1997; pp 1-35.