Download PDF
Clin Colon Rectal Surg 2013; 26(03): 191-196
DOI: 10.1055/s-0033-1351138
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Postoperative Pain Control

Veerabhadram Garimella
1   Division of Colorectal Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
,
Christina Cellini
1   Division of Colorectal Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
› Author Affiliations
Further Information

Publication History

Publication Date:
19 August 2013 (online)

    Permissions and Reprints

Abstract

The effective relief of pain is of the utmost importance to anyone treating patients undergoing surgery. Pain relief has significant physiological benefits; hence, monitoring of pain relief is increasingly becoming an important postoperative quality measure. The goal for postoperative pain management is to reduce or eliminate pain and discomfort with a minimum of side effects. Various agents (opioid vs. nonopioid), routes (oral, intravenous, neuraxial, regional) and modes (patient controlled vs. “as needed”) for the treatment of postoperative pain exist. Although traditionally the mainstay of postoperative analgesia is opioid based, increasingly more evidence exists to support a multimodal approach with the intent to reduce opioid side effects (such as nausea and ileus) and improve pain scores. Enhanced recovery protocols to reduce length of stay in colorectal surgery are becoming more prevalent and include multimodal opioid sparing regimens as a critical component. Familiarity with the efficacy of available agents and routes of administration is important to tailor the postoperative regimen to the needs of the individual patient.

Keywords

postoperative - analgesia - opioids - nonsteroidal - transversus abdominis
 

  • References

  • 1 American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 2012; 116 (2) 248-273
    CrossrefPubMedGoogle Scholar
  • 2 Brennan F, Carr DB, Cousins M. Pain management: a fundamental human right. Anesth Analg 2007; 105 (1) 205-221
    CrossrefPubMedGoogle Scholar
  • 3 Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth 2001; 87 (1) 62-72
    CrossrefPubMedGoogle Scholar
  • 4 Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet 2006; 367 (9522) 1618-1625
    CrossrefPubMedGoogle Scholar
  • 5 Kalkman CJ, Visser K, Moen J, Bonsel GJ, Grobbee DE, Moons KG. Preoperative prediction of severe postoperative pain. Pain 2003; 105 (3) 415-423
    CrossrefPubMedGoogle Scholar
  • 6 Abrishami A, Chan J, Chung F, Wong J. Preoperative pain sensitivity and its correlation with postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology 2011; 114 (2) 445-457
    CrossrefPubMedGoogle Scholar
  • 7 Caumo W, Schmidt AP, Schneider CN , et al. Preoperative predictors of moderate to intense acute postoperative pain in patients undergoing abdominal surgery. Acta Anaesthesiol Scand 2002; 46 (10) 1265-1271
    CrossrefPubMedGoogle Scholar
  • 8 Gunningberg L, Idvall E. The quality of postoperative pain management from the perspectives of patients, nurses and patient records. J Nurs Manag 2007; 15 (7) 756-766
    CrossrefPubMedGoogle Scholar
  • 9 Shuldham CM, Fleming S, Goodman H. The impact of pre-operative education on recovery following coronary artery bypass surgery. A randomized controlled clinical trial. Eur Heart J 2002; 23 (8) 666-674
    CrossrefPubMedGoogle Scholar
  • 10 Walker JA. What is the effect of preoperative information on patient satisfaction?. Br J Nurs 2007; 16 (1) 27-32
    PubMedGoogle Scholar
  • 11 Ong CK, Lirk P, Seymour RA, Jenkins BJ. The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg 2005; 100 (3) 757-773 table of contents.
    CrossrefPubMedGoogle Scholar
  • 12 Ghezzi F, Cromi A, Bergamini V , et al. Preemptive port site local anesthesia in gynecologic laparoscopy: a randomized, controlled trial. J Minim Invasive Gynecol 2005; 12 (3) 210-215
    CrossrefPubMedGoogle Scholar
  • 13 Leung CC, Chan YM, Ngai SW, Ng KF, Tsui SL. Effect of pre-incision skin infiltration on post-hysterectomy pain—a double-blind randomized controlled trial. Anaesth Intensive Care 2000; 28 (5) 510-516
    PubMedGoogle Scholar
  • 14 Barletta JF, Asgeirsson T, Senagore AJ. Influence of intravenous opioid dose on postoperative ileus. Ann Pharmacother 2011; 45 (7-8) 916-923
    CrossrefPubMedGoogle Scholar
  • 15 Goettsch WG, Sukel MP, van der Peet DL, van Riemsdijk MM, Herings RM. In-hospital use of opioids increases rate of coded postoperative paralytic ileus. Pharmacoepidemiol Drug Saf 2007; 16 (6) 668-674
    CrossrefPubMedGoogle Scholar
  • 16 Levy BF, Tilney HS, Dowson HM, Rockall TA. A systematic review of postoperative analgesia following laparoscopic colorectal surgery. Colorectal Dis 2010; 12 (1) 5-15
    CrossrefPubMedGoogle Scholar
  • 17 Zafar N, Davies R, Greenslade GL, Dixon AR. The evolution of analgesia in an 'accelerated' recovery programme for resectional laparoscopic colorectal surgery with anastomosis. Colorectal Dis 2010; 12 (2) 119-124
    CrossrefPubMedGoogle Scholar
  • 18 Keeri-Szanto M, Remington B. Drug levels on continuous intravenous infusion. Lancet 1971; 2 (7724) 601
    PubMedGoogle Scholar
  • 19 Evans JM, Rosen M, MacCarthy J, Hogg MI. Apparatus for patient-controlled administration of intravenous narcotics during labour. Lancet 1976; 1 (7949) 17-18
    PubMedGoogle Scholar
  • 20 Ballantyne JC, Carr DB, Chalmers TC, Dear KB, Angelillo IF, Mosteller F. Postoperative patient-controlled analgesia: meta-analyses of initial randomized control trials. J Clin Anesth 1993; 5 (3) 182-193
    CrossrefPubMedGoogle Scholar
  • 21 Hudcova J, McNicol E, Quah C, Lau J, Carr DB. Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain. Cochrane Database Syst Rev 2006; (4) CD003348
    PubMedGoogle Scholar
  • 22 Werawatganon T, Charuluxanun S. Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database Syst Rev 2005; (1) CD004088
    PubMedGoogle Scholar
  • 23 Marret E, Remy C, Bonnet F, Postoperative Pain Forum G. Postoperative Pain Forum Group. Meta-analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery. Br J Surg 2007; 94 (6) 665-673
    CrossrefPubMedGoogle Scholar
  • 24 Mann C, Pouzeratte Y, Boccara G , et al. Comparison of intravenous or epidural patient-controlled analgesia in the elderly after major abdominal surgery. Anesthesiology 2000; 92 (2) 433-441
    CrossrefPubMedGoogle Scholar
  • 25 Hermanides J, Hollmann MW, Stevens MF, Lirk P. Failed epidural: causes and management. Br J Anaesth 2012; 109 (2) 144-154
    CrossrefPubMedGoogle Scholar
  • 26 Virlos I, Clements D, Beynon J, Ratnalikar V, Khot U. Short-term outcomes with intrathecal versus epidural analgesia in laparoscopic colorectal surgery. Br J Surg 2010; 97 (9) 1401-1406
    CrossrefPubMedGoogle Scholar
  • 27 Levy BF, Scott MJ, Fawcett W, Fry C, Rockall TA. Randomized clinical trial of epidural, spinal or patient-controlled analgesia for patients undergoing laparoscopic colorectal surgery. Br J Surg 2011; 98 (8) 1068-1078
    CrossrefPubMedGoogle Scholar
  • 28 Wongyingsinn M, Baldini G, Stein B, Charlebois P, Liberman S, Carli F. Spinal analgesia for laparoscopic colonic resection using an enhanced recovery after surgery programme: better analgesia, but no benefits on postoperative recovery: a randomized controlled trial. Br J Anaesth 2012; 108 (5) 850-856
    CrossrefPubMedGoogle Scholar
  • 29 Lowder JL, Shackelford DP, Holbert D, Beste TM. A randomized, controlled trial to compare ketorolac tromethamine versus placebo after cesarean section to reduce pain and narcotic usage. Am J Obstet Gynecol 2003; 189 (6) 1559-1562 , discussion 1562
    CrossrefPubMedGoogle Scholar
  • 30 Dajani EZ, Islam K. Cardiovascular and gastrointestinal toxicity of selective cyclo-oxygenase-2 inhibitors in man. J Physiol Pharmacol 2008; 59 (Suppl. 02) 117-133
    PubMedGoogle Scholar
  • 31 De Oliveira Jr GS, Agarwal D, Benzon HT. Perioperative single dose ketorolac to prevent postoperative pain: a meta-analysis of randomized trials. Anesth Analg 2012; 114 (2) 424-433
    CrossrefPubMedGoogle Scholar
  • 32 Pavy TJ, Paech MJ, Evans SF. The effect of intravenous ketorolac on opioid requirement and pain after cesarean delivery. Anesth Analg 2001; 92 (4) 1010-1014
    PubMedGoogle Scholar
  • 33 Chen JY, Wu GJ, Mok MS , et al. Effect of adding ketorolac to intravenous morphine patient-controlled analgesia on bowel function in colorectal surgery patients—a prospective, randomized, double-blind study. Acta Anaesthesiol Scand 2005; 49 (4) 546-551
    CrossrefPubMedGoogle Scholar
  • 34 Chen JY, Ko TL, Wen YR , et al. Opioid-sparing effects of ketorolac and its correlation with the recovery of postoperative bowel function in colorectal surgery patients: a prospective randomized double-blinded study. Clin J Pain 2009; 25 (6) 485-489
    CrossrefPubMedGoogle Scholar
  • 35 Toms L, McQuay HJ, Derry S, Moore RA. Single dose oral paracetamol (acetaminophen) for postoperative pain in adults. Cochrane Database Syst Rev 2008; (4) CD004602
    PubMedGoogle Scholar
  • 36 Maund E, McDaid C, Rice S, Wright K, Jenkins B, Woolacott N. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs for the reduction in morphine-related side-effects after major surgery: a systematic review. Br J Anaesth 2011; 106 (3) 292-297
    CrossrefPubMedGoogle Scholar
  • 37 Ong CK, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg 2010; 110 (4) 1170-1179
    PubMedGoogle Scholar
  • 38 Charlton S, Cyna AM, Middleton P, Griffiths JD. Perioperative transversus abdominis plane (TAP) blocks for analgesia after abdominal surgery. Cochrane Database Syst Rev 2010; (12) CD007705
    PubMedGoogle Scholar
  • 39 Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia 2001; 56 (10) 1024-1026
    PubMedGoogle Scholar
  • 40 Brady RR, Ventham NT, Roberts DM, Graham C, Daniel T. Open transversus abdominis plane block and analgesic requirements in patients following right hemicolectomy. Ann R Coll Surg Engl 2012; 94 (5) 327-330
    CrossrefPubMedGoogle Scholar
  • 41 Conaghan P, Maxwell-Armstrong C, Bedforth N , et al. Efficacy of transversus abdominis plane blocks in laparoscopic colorectal resections. Surg Endosc 2010; 24 (10) 2480-2484
    CrossrefPubMedGoogle Scholar
  • 42 Scott NB. Wound infiltration for surgery. Anaesthesia 2010; 65 (Suppl. 01) 67-75
    CrossrefPubMedGoogle Scholar
  • 43 Haas E, Onel E, Miller H, Ragupathi M, White PF. A double-blind, randomized, active-controlled study for post-hemorrhoidectomy pain management with liposome bupivacaine, a novel local analgesic formulation. Am Surg 2012; 78 (5) 574-581
    PubMedGoogle Scholar
  • 44 Cohen SM. Extended pain relief trial utilizing infiltration of Exparel(®), a long-acting multivesicular liposome formulation of bupivacaine: a Phase IV health economic trial in adult patients undergoing open colectomy. J Pain Res 2012; 5: 567-572
    PubMedGoogle Scholar
  • 45 Schug SA, Raymann A. Postoperative pain management of the obese patient. Best Pract Res Clin Anaesthesiol 2011; 25 (1) 73-81
    CrossrefPubMedGoogle Scholar
  • 46 Batistich S, Kendall A, Somers S. Analgesic requirements in morbidly obese patients. Anaesthesia 2004; 59 (5) 510-511
    PubMedGoogle Scholar
  • 47 Richebé P, Beaulieu P. Perioperative pain management in the patient treated with opioids: continuing professional development. Can J Anaesth 2009; 56 (12) 969-981
    PubMedGoogle Scholar