Review Article - Postoperative pain and its management

Postoperative pain is both distressing and detrimental for the patient. The management of postoperative pain involves assessment of the pain in terms of intensity at rest and activity associated pain, treatment by pharmacological and non pharmacological means as well as monitoring induced side-effects. Besides being physically and emotionally disabling, the pain is associated with various physiological effects involving the increased perioperative stress response. The pain causes the patient to remain immobile, thus becoming vulnerable to DVT, pulmonary atelectasis, muscle wasting and urinary retention. Poor control of postoperative pain could be due to various reasons which may include uniformed prescribing without taking into consideration the individual patient′s physical status, the surgery that has been performed or the site and intensity of pain. Besides, the poor compliance of orders in administrating the analgesics prescribed and the fact that optimal pain relief is not aimed for may also contribute to the inadequate management of the pain occurring in the postoperative period. Thus, despite all efforts, there continues to be inadequate pain relief in a large majority of patients. The introduction of multimodal analgesia including opioids and non-opioids, delivered through various routes, neuraxial use of local anesthetics, either alone or in combination with other drugs, nerve blocks, antihyperalgesics and techniques such as patient controlled analgesia and pre-emptive analgesia have greatly improved the efficacy of pain-control while minimizing the side-effects of any one modality. The recent recommendation of planning the pain services in an organized manner and implementation of Acute Pain Services (APS) has proven to be beneficial and rewarding.