Current issues in

postoperative pain
management
HELLO!
I am Nabila Vika

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INTRODUCTION

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THIS IS A SLIDE TITLE

▰ Pain relief after surgery continues to be a

major medical challenge.
▰ Poorly managed postoperative pain may
delay discharge and recovery  patient’s
inability to participate in rehabilitation
programmes  poor outcomes.
▰ Recent advances are available in pain
management.
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Problem
▰ Advances in pain managements have not led to
any major improvements, and undertreatment of
postoperative pain continues as a considerable
problem worldwide.
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 POSTOPERATIVE PAIN

Prevalence of Persistent postoperative

postoperative pain pain
▰ Worldwide survey ▰ Persistent postoperative
concluded that the pain (PPP) is a major cause
management of of chronic pain and
postoperative pain was therefore an important
suboptimal. public health problem
▰ Certain categories of ▰ Given the very high
patients are at a prevalence, it is time to
greater risk of being include the risk of PPP in
undertreated including preoperative information
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 PHARMACOLOGICAL MANAGEMENT

Opioid therapy
Multimodal analgesia
▰ Opioids are widely used
▰ the main aim is to reduce
because they are highly
or eliminate the use of
effective for relieving
strong opioids which are
moderate-to-severe
recognised to have many
postoperative pain, do not
disadvantages and
have a ceiling effect and are
unacceptable side-effects.
available in a wide variety of
formulations, thus remains ▰ the benefits of combining
the foundation of other nonopioids is
postsurgical pain therapy. overrated, the side-effects
generally ignored and 7the
▰ However, opioids have many
role of combining more
 REGIONAL ANAESTHESIA TECHNIQUES

Epidural techniques Perineural techniques

▰ the advantages of ▰ there is convincing
epidural analgesia are evidence about the
not as impressive as efficacy and feasibility of
formerly believed and peripheral nerve blocks to
the risks are greater manage pain, and using
than estimated in the catheter techniques
past. prolong the duration of
▰ Epidural analgesia can analgesia for an unlimited
time.
no longer be considered
the ‘gold standard’ as a ▰ routine use of these 8
 INFILTRATIVE TECHNIQUES

Wound infiltration catheter infusion techniques

▰ Direct application of ▰ The technique involves
local anaesthetics to catheters placed in a number
the surgical site is a of sites including
rational approach to subcutaneous, subfascial,
block pain transmission preperitoneal, intraperitoneal,
from afferent subacromial, intraosseous,
nociceptive barrage. intra-articular and others
▰ Surgeon-administered ▰ Wound catheter infusions was
wound infiltration at the effective across a variety of
end of surgery is a surgical procedures 9
 INFILTRATIVE TECHNIQUES

Local infiltration catheter infusion techniques

analgesia (LIA) ▰ The technique involves
▰ LIA is a major recent catheters placed in a number
development in lower of sites including
extremity joint subcutaneous, subfascial,
replacement surgery. preperitoneal, intraperitoneal,
▰ controlled trials are subacromial, intraosseous,
intra-articular and others
necessary to address
the many unanswered ▰ Wound catheter infusions was
questions such as the effective across a variety of
role of intra-articular surgical procedures 10
 INFILTRATIVE TECHNIQUES

Intraperitoneal local Transversus abdominis plane

anaesthetics blocks
▰ intraperitoneal use of ▰ TAP infiltration has been used
local anaesthetic in successfully in bowel surgery,
laparoscopic appendicectomy, hernia
cholecystectomy was repair, umbilical surgery and
shown to reduce pain, gynaecological surgery.
opioid use and the need
for rescue.
▰ The technique has been
demonstrated to be 11
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 CURRENT MANAGEMENT GUIDELINES

▰ All pain management ▰ Procedure-specific

guidelines advocate
generalised ‘one size fits
all’ recommendations for
the use of analgesic
drugs and techniques.
Postoperative Pain
Management (PROSPECT)
group guidelines are such a
source of evidence based,
procedure-specific
recommendations from an
international group of
anaesthesiologists and
surgeons.
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ACUTE PAIN SERVICES

▰ APS with a ▰ most APSs worldwide

multidisciplinary did not meet basic
team approach has quality criteria,
received widespread defined as regular
formal acceptance recording of pain
from national and scores at least once
international a day, written
organisations. protocols, dedicated
▰ Worldwide, the personnel and
policies for pain
number of hospitals
management during 14
with an APS seems to
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 CONCLUSION
▰decades-old problem of undertreated
postoperative pain is not because of lack of
effective drugs or techniques but to a lack of an
organised, multidisciplinary approach (APS) which
uses existing treatments.
▰Irrespective of the APS model, teaching
programmes to upgrade the role of ward nurses,
standardised protocols and regular audits are
necessary to address the problem. 16
 THANKS!
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