Prevention and treatment of postoperative pain

Abstract

Surgical intervention is traumatic, direct lesions to neural structures or an excitation of nociceptors can lead to the perception of pain. Pain causes stress not only in psychological, but also in pathophysiological sense. The understanding of the different origins of acute postoperative pain serves as a base for the design of the therapeutic approach. On the very beginning of the therapeutic considerations, a sufficient amount of basic information about the planned intervention must be provided. This data is needed not only for the planning of the anesthetic procedure, but serves as a source of information about the patient. The analgesic therapy is based upon three types of substances; opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Opioids have been the backbone of the peri- and postoperative analgesia. Their analgesic effect is acompanied by annoying side effects as pruritus, nausea, vomitus, constipation, urinary retention, sedation and respiratory depression. NSAIDs are acting mainly peripherally, and therefore suitable for combination with centrally acting opioids. Local anesthetics are frequently used for postoperative analgesia, mostly via the epidural route. Analgesia can be administered by different routes. The major goals of prevention and treatment of postoperative pain are to minimize or eliminate discomfort, to facilitate the recovery process, to avoid or effectively manage side effects associated with the therapy, and to make the therapy cost effective.