Articles: postoperative-pain.
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Optimal care of surgical patients includes effective control of incisional pain. Attention is beginning to be focused on new in-hospital services created to improve the management of postoperative pain. Additional information regarding the organization and operation of this type of service, especially in the framework of a university hospital, is presented. The specific roles of an academic anesthesiologist involved in acute pain management are: to provide leadership by the development of effective services, to clarify through research optimal treatments, to train future practitioners in the management of acute pain, and to serve as a consultant for improving pain control for the whole medical community.
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An updated review of patient-controlled analgesia (PCA) for acute pain relief in the postoperative period is presented. The technique, becoming more and more popular with patients, surgeons, and nurses, is undergoing numerous clinical trials under a variety of clinical protocols that are currently being reviewed. Benefits found with PCA include the fact that it is individualized therapy, allowing optimum drug titration; it decreases a patient's anxiety in the postoperative period; and it is a safer and more efficient technique of acute pain relief than conventional therapy. ⋯ Contraindications to the technique and most current equipment in use are listed herein. Clinical experience with PCA at Georgetown University Medical Center has provided, as has been the case elsewhere, data showing the superiority of the technique and its wide acceptance as part of the Acute Pain Service. The anesthesiologist plays a vital role in coordinating the various people and aspects involved in PCA for postoperative pain relief.
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Physicians have in their armamentaria of drugs and techniques sufficient methods of relieving postoperative pain to maintain an analgesic state in postsurgical patients. The extent of the problem, and the options available, are discussed and described.
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Sixty-six patients undergoing total knee arthroplasty were offered epidural morphine as a method of postoperative analgesia. Of the 66 patients, 50 completed the minimum protocol of 3 days in a special epidural monitoring unit and were thus available for study. In this study group, 86% stated that they obtained 75-100% relief of pain with each epidural injection. ⋯ Epidural morphine provided excellent but inconsistent postoperative pain relief. When relief was present, aggressive in-house rehabilitation could be instituted, and a shorter overall hospital stay was achieved when compared with conventional analgesia. Nonetheless, the related adverse effects and inconsistent pain relief on many patients may preclude the use of epidural morphine as a single postoperative analgesic agent.