• Eugene R Viscusi.
• Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. eugene.viscusi@fefferson.edu
• Am J Health Syst Pharm. 2007 Mar 15;64(6 Suppl 4):S6-S11.

PurposeThe advantages and disadvantages of intravenous patient-controlled analgesia (i.v. PCA) and epidural analgesia are discussed. New approaches to the management of patients with acute post-operative pain are described. The results of controlled clinical trials with these modalities are presented.SummaryIntravenous patient-controlled analgesia, while effective, is a burdensome technology requiring approximately 125 steps and at least 6 staff members. Furthermore, medication and pump programming errors may lead to patient injury. Epidural analgesia via catheter has a high reported failure rate, causing analgesic gaps and requiring a high level of staff intervention. In a clinical trial involving hip arthroplasty, extended-release epidural morphine demonstrated a 48-hour duration of action with a marked reduction in need for supplemental analgesia. The fentanyl Iontophoretic Transdermal System has demonstrated therapeutic equivalence with morphine intravenous patient-controlled analgesia and similar safety. Selective opioid antagonists are under development that may selectively block gastrointestinal opioid receptors while preserving analgesia.ConclusionRecently approved agents and those in development may address a variety of unmet needs in the management of patients with post-operative pain.

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