ABSTRACT:
Postoperative incisional pain is a common form of acute pain. Recent studies demonstrate that about 50–70% of patients experience moderate to severe pain after surgery. Reasons for this quandary are distinct mechanisms of incisional nociception compared to other pain conditions or lack of an in depth knowledge about the pathophysiology and neuropharmacology of postoperative pain. Acute postoperative pain is followed by chronic pain in 10–50% of individuals which can be severe in about 2-10% of patients undergoing common operations such as groin hernia repair, breast and thoracic surgery, leg amputation, and coronary artery bypass surgery. Therefore, persistent postsurgical pain represents a major, largely unrecognised clinical problem. Iatrogenic neuropathic pain is probably the most important cause of long-term postsurgical pain. Consequently, surgical techniques that avoid nerve damage should be applied whenever possible. Major surgical operations are still followed by pain, organ dysfunction and prolonged convalescence. It has been assumed that sufficient pain relief will improve the surgical outcome with reduced morbidity, need for hospitalization and convalescence. It has been realized that several other factors in perioperative management are important in the control of postoperative recovery and rehabilitation, and that these factors must be considered and revised in order to achieve the advantageous effects of pain relief on outcome. Among the most commonly used pain-relieving techniques [patient-controlled analgesia (PCA) with opioids, non-steroidal anti-inflammatory drugs (NSAIDs) and epidural analgesic techniques], there is evidence that the epidural local anaesthetic or local anaesthetic–opioid techniques are the most effective on providing dynamic pain relief after major surgical procedures. The goal of postoperative pain management is to relieve the pain while keeping side effects to a minimum. This can be best accomplished with a multimodal approach. Minimally invasive surgery and enhanced recovery protocols have addressed pain management in terms of these goals.