Canadian Journal of Anesthesia, Vol 40, R19-R28, Copyright © 1993 by Canadian Anesthesiologists' Society

ARTICLES

Techniques for post-op pain management in the adult

C Moote
Department of Anaesthesia, University of Western Ontario, London, Ontario.

Nurse-administered analgesia is simple, universally accessible, and cost-effective. This route of administration must be fully explored and exploited to gain maximal analgesia at minimal cost. Combined, balanced multimodal analgesia with NSAIDs and opioids used preoperatively to prevent pain should be encouraged. Intraoperative analgesia should not consist solely of opioids, but also local anaesthetics and NSAIDs. Postoperatively, balanced analgesia should continue and when the patient is able to tolerate fluids the oral route of administration should be used. The solution to improved postoperative analgesia lies in exploitation and liberalization of traditional analgesic drugs and techniques. We do not need new pharmacology or new technology. We need to use the drugs and techniques we already have in a much more effective and efficient fashion. Anaesthetists have been at the forefront of delivering superb analgesia to patients after extensive major surgical procedures using epidural analgesia and patient-controlled analgesia. We must focus on postoperative pain management of all patients to ensure that optimal analgesia is provided throughout the institution. This requires a multi-disciplinary team of health care professionals and a multi-modal array of analgesics. This approach represents a change from current practice. Considerable time and energy has been invested in the development of the clinical practice guidelines and they deserve our consideration as we manage patients now and in the future.