Anesthesiology clinics of North America
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Procedure-specific postoperative pain management guidelines arguably are more helpful to the clinician than general pain guidelines or guidelines based on the use of the Oxford League Tables. Two sources, the United States Veteran's Health Administration and the European Prospect Working Group, offer websites that include surgical procedure-specific postoperative pain management guidelines, which are available and currently updated.
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Anesthesiol Clin North America · Mar 2005
ReviewPostoperative care of the chronic opioid-consuming patient.
Recently, there has been a significant increase in the use of opioid analgesics for chronic pain in the outpatient setting. As a result, anesthesiologists are commonly presented with the dilemma of treating acute postoperative pain in patients who do not receive adequate analgesia with conventional doses of opioid. This article presents a practical approach to treating postoperative pain in the chronic opioid-consuming patient. Specifically, a technique based on pharmacokinetic modeling is described that predicts safe and therapeutic opioid dosing in these patients.
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There is increased awareness of the need for effective postoperative analgesia in infants and young children. A multi-modal approach to preventing and treating pain usually is used. Mild analgesics, local and regional analgesia, and opioids when indicated, frequently are combined to minimize adverse effects of individual drugs or techniques.
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Anesthesiol Clin North America · Mar 2005
ReviewRole of analgesic adjuncts in postoperative pain management.
Postoperative pain remains a major problem. A multi-modal analgesic approach is recommended to optimize pain management and reduce opiate-related adverse effects. Several analgesic adjuncts have been investigated, and many have proved to have a useful analgesic effect. This article reviews the literature regarding use of analgesic adjuncts in the perioperative period.
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Anesthesiol Clin North America · Mar 2005
ReviewOrganization, function, and implementation of acute pain service.
Undertreatment of postoperative pain continues to be a major problem internationally. The solution does not seem to be the development of new analgesic drugs or technologies but the development of an appropriate organization that utilizes existing expertise. ⋯ Although the number of hospitals with an APS is increasing, the literature is unclear about the optimal structure, staffing, and function. There is a need for the development of well-defined APS criteria with which to assess performance and compare with national standards.