Postoperative pain management

STRESS GENERATED by surgical trauma is responsible for a large number of physiologic and biochemical aberrations, which may negatively affect surgical outcomes if not managed properly. One of the main advantages of adequate postoperative pain therapy is the reduction of the stress response. The basis for the management of all severe pain is opioid therapy, which has advantages and disadvantages; however, the disadvantages should not discourage their use. The most effective method of parenterally delivering opioids is patient- controlled analgesia, the safety and efficacy of which is well established. Neuraxial administration of analgesics is an even more versatile method of postoperative pain management. Adjuvant agents, such as nonsteroidal antiinflammatory drugs, antidepressants, antiemetics, anxiolytics, and anticonvulsants, must be viewed as components of a multimodal approach to the management of postoperative pain. Consideration should also be given to nonpharmacologic modalities when standard regimens fail or side effects become difficult to manage.