Lange Anesthesiology > Section III. Regional Anesthesia & Pain Management > Chapter 18. Pain Management

Postoperative Pain

"The concept of "preemptive" analgesia (above) suggests that the best postoperative pain management begins preoperatively. Some studies suggest that anesthetic techniques can also reduce the neuroendocrine stress response to surgery and pain. Regional anesthetic techniques in which a catheter can be left in place also provide an excellent means for postoperative analgesia. Intercostal and epidural anesthesia can additionally improve respiratory function following thoracic and upper abdominal operations and encourage early ambulation. Epidural and possibly spinal anesthesia reduce the incidence of thromboembolism following hip surgery and attenuate the hypercoagulation state following vascular procedures.Most patients who have mild to moderate pain following surgery can be managed with oral COX inhibitors, opioids, or a combination. Patients unable to resume an oral intake or with severe pain require inpatient admission regardless of the procedure.Oral nonopioid analgesics include salicylates, acetaminophen, and NSAIDs (Table 18–12). These agents inhibit prostaglandin synthesis (COX) and have varying analgesic, antipyretic, and antiinflammatory properties. Acetaminophen lacks significant antiinflammatory activity. Analgesia is due to blockade of prostaglandin synthesis, which sensitizes and amplifies nociceptive input (above). Some types of pain, particularly pain that follows orthopedic and gynecological surgery, respond very well to these agents, suggesting an important role for prostaglandins. COX inhibitors..."