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. Postoperative

pain control is generally best managed by anesthesiologists, because they offer

regional anesthetic techniques as well as pharmacological expertise in analgesics.

Concerns over increased cost may be unjustified because some studies have

demonstrated lower mortality and morbidity, as well as reduced hospital costs, with

these techniques. Postoperative analgesic modalities include oral or parenteral

analgesics, peripheral nerve blocks, neuraxial blocks with local anesthetics,

intraspinal opioids, as well as adjunctive techniques such as TENS and physical

therapy. Selection of analgesic techniques is generally based on three factors: the

patient, the procedure, and the setting (inpatient versus outpatient).