TY - JOUR
AU - Weitz, Sandra
AB - Abstract Objectives: To examine the relationship between analgesia and clinical outcome and to review new methods of delivering opioid analgesics and new pharmacologic analgesic agents. Data Sources: A computer-assisted search of the literature on postoperative pain management, and a review of those areas in which new approaches have led to a change in clinical practice. Results: Current research focuses on the ability of analgesia to decrease perioperative complications. Recent advances allow enhanced postoperative analgesia with a low incidence of side effects. Administration of opioids via a patient-controlled device or via an epidural catheter yields excellent analgesia with a low rate of side effects compared with intramuscular opioids. Several non-narcotic, parenteral drugs, including ketorolac tromethamine and α2-adrenergic agonists are now available. These drugs decrease opioid requirement, and thus the rate of serious side effects, including respiratory depression. Moreover, because these drugs act at sites other than opioid receptors, they may enhance the quality of analgesia at the same time they decrease opioid requirement. Conclusions: New technology and new agents allow more rational management of postoperative pain. Use of these techniques results in increased patient satisfaction and may improve clinical outcome.(Arch Surg. 1994;129:128-132) References 1. Acute Pain Management Panel. Acute Pain Management: Operative or Medical Procedures and Trauma—Clinical Practice Guideline . Rockville, Md: Agency for Health Care Policy and Research, Public Health Service, US Dept of Health and Human Services; 1992. Agency for Health Care Policy and Research publication 92-0032. 2. Wisner D. A stepwise logistic regression analysis of factors affecting morbidity and mortality after thoracic trauma: effect of epidural analgesia . J Trauma . 1990; 30:799-804.Crossref 3. Nielsen T, Nielsen H, Husted S, Hansen S, Olsen K, Fjeldborg N. Stress response and platelet function in minor surgery during epidural bupivacaine and general anesthesia: effect of epidural morphine addition . Eur J Anaesthesiol . 1989;6:409-417. 4. Halter J, Pflug A, Porte D. Mechanisms of plasma catecholamine increase during surgical stress in man . J Clin Endocrinol Metab . 1977;45:936-944.Crossref 5. Bromage P, Camporesi E, Chestnut D. Epidural narcotics for postoperative analgesia . Anesth Analg . 1980:59:473-480.Crossref 6. Craig P. Postoperative recovery of pulmonary function . Anesth Analg . 1981; 60:46-52. 7. Mangano D. Perioperative cardiac morbidity . Anesthesiology . 1990;72:153-184.Crossref 8. Silicano D, Mangano D. Postoperative myocardial ischemia: mechanisms and therapies . In: Estanafous FG. ed. Opioids in Anesthesia . Woburn, Mass: Butterworths; 1989:164-178. 9. Sinclair M, Sear J, Summerfield R, Fisher A. Alfentanil infusions on the intensive therapy unit . Intensive Care Med . 1988:14:55-59.Crossref 10. Roizen M, Lampe G, Benefiel D. Is increased operative stress associated with worse outcome? Anesthesiology . 1987;67:A1. Abstract.Crossref 11. Kehlet H. Stress-free anesthesia and surgery . Acta Anaesthesiol Scand . 1979; 23:503-504.Crossref 12. Kehlet H. The modifying effect of general and regional anesthesia on the endocrine and metabolic response to surgery . Reg Anesth . 1982;7:539-546. 13. Udelsman R, Norton J. Jelenich S. Responses of the hypothalamic-pituitary adrenal and renin angiotensin axes and the sympathetic system during controlled surgical and anesthetic stress . J Clin Endocrinol Metab . 1987;64:986-994.Crossref 14. Mangano D, Browner W, Hollenberg M, London M, Tubau J, Tateo I. Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery . N Engl J Med . 1990;323:1781-1788.Crossref 15. Mangano D, Wong M, London M, Tubau J, Rapp J. Perioperative myocardial ischemia in patients undergoing noncardiac surgery, II: incidence and severity during the first week following surgery . J Am Coll Cardiol . 1991;17:851-857.Crossref 16. Mangano D, Hollenberg M. Fegert G, et al. Perioperative myocardial ischemia in patients undergoing noncardiac surgery, I: incidence and severity during the 4-day perioperative period . J Am Coll Cardiol . 1991;17:843-850.Crossref 17. Knight A. Hollenberg M, London M. et al. Perioperative myocardial ischemia: importance of the preoperative ischemic pattern . Anesthesiology . 1988;68: 681-688.Crossref 18. Knight A, Hollenberg M, London M, Mangano D. Myocardial ischemia in patients awaiting coronary artery bypass surgery . Am Heart J . 1989;117:1189-1196.Crossref 19. Yeager M, Glass D, Neff R, Brinck-Johnsen T. Epidural anesthesia and analgesia in high risk surgical patients . Anesthesiology . 1987;66:729-736.Crossref 20. Tuman K, McCarthy R, March R, DeLaria G, Patel R, Ivankovich A. Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery . Anesth Analg . 1991;73:696-704.Crossref 21. Odoom J, Bovill J, Hardeman M, Oosting J, Zuurmond W. Effects of epidural and spinal anesthesia on blood rheology . Anesth Analg . 1992;74:835-840.Crossref 22. Owen H, McMillan V, Rogowski D. Postoperative pain therapy: a survey of patients expectations and their experiences . Pain . 1990;41:303-307.Crossref 23. Austin K, Stapleton J, Mather L. Multiple intramuscular injections: a major source of variability in analgesic response to meperidine . Pain . 1980;8:47-62.Crossref 24. Daley M, Sandier A, Turner K, Vosu H, Slavchenko P. A comparison of epidural and intramuscular morphine in patients folowing cesarean section . Anesthesiology . 1990;72:289-294.Crossref 25. Donovan M, Dillon P, McGuire L. Incidence and characteristics of pain in a sample of medical-surgical inpatients . Pain . 1987;30:69-78.Crossref 26. Marks R, Sachar E. Undertreatment of medical inpatients with narcotic analgesics . Ann Intern Med . 1973;78:173-181.Crossref 27. Harrison D, Sinatra R, Morgese L, Chung J. Epidural narcotic and patientcontrolled analgesia for post-cesarean section pain relief . Anesthesiology . 1988; 68:454-457.Crossref 28. Eisenach J, Grice S, Dewan D. Patient-controlled analgesia following cesarean section: a comparison with epidural and intramuscular narcotics . Anesthesiology . 1988;68:444-448.Crossref 29. Owen H, Szekely S, Plummer J, Cushnie J, Mather L. Variables of patientcontrolled analgesia, II: concurrent infusion . Anaesthesia . 1989:44:11-13.Crossref 30. Parker R, Holtmann B, White P. Patient-controlled analgesia: does a concurrent opioid infusion improve pain management after surgery? JAMA . 1991; 266:1947-1952.Crossref 31. Parker R, Holtmann B, White P. Effects of a nighttime opioid infusion with PCA therapy on patient comfort and analgesic requirements after abdominal hysterectomy . Anesthesiology . 1992;76:362-367.Crossref 32. Yaksh T. Spinal opiate analgesia: characteristics and principles of action . Pain . 1981;11:293-346.Crossref 33. Cousins M, Mather L. Intrathecal and epidural administration of opioids . Anesthesiology . 1984;61:276-310.Crossref 34. Ahn H, Bronge A, Johansson K, Ygge H, Lindhagen J. Effects of continuous postoperative epidural analgesia on intestinal motility . Br J Surg . 1988;75: 1175-1178.Crossref 35. Thoren T, Sundberg A, Wattwil M, Garvill J-E, Jurgensen U. Effects of epidural bupivacaine and epidural morphine on bowel function and pain after hysterectomy . Acta Anaesthiol Scand . 1989;33:181-185.Crossref 36. Thoren T, Tanghoj H, Wattwil M. Jarnerot G. Epidural morphine delays gastric emptying and small intestine transit in volunteers . Acta Anaesthiol Scand . 1989; 33:174-180.Crossref 37. O'Hara DA, Fragen RJ, Kinzer M, Pemberton D. Ketorolac tromethamine as compared with morphine sulfate for treatment of postoperative pain . Clin Pharmacol Ther . 1987;41:556-561.Crossref 38. Powell H, Smallman JM, Morgan M. Comparison of intramuscular ketorolac and morphine in pain control after laparotomy . Anaesthesia . 1990;45:538-542.Crossref 39. Yee JP, Koshiver JE, Albon C, Brown CR. Comparison of intramuscular ketorolac tromethamine and morphine sulfate for analgesia of pain after major surgery . Pharmacotherapy . 1986;6:253-261. 40. Burns JW, Aitken HA, Bullingham RES, McArdle CS, Kenny GNC. Double-blind comparison of the morphine sparing effect of continuous and intermittent IM administration of ketorolac . Br J Anaesth . 1991;67:235-238.Crossref 41. Buckley MM, Brogden RN. Ketorolac: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential . Drugs . 1990;39:86-109.Crossref 42. DiPalma JR. Ketorolac: an injectable NSAID . Am Fam Physician . 1991:43:207-210. 43. Camu F, Van OL, Bullingham R, Lloyd J. Hemodynamic effects of two intravenous doses of ketorolac tromethamine compared with morphine . Pharmacotherapy . 1990;10:122S-126S. 44. Bravo LJ, Mattie H, Spierdijk J, Bovill JG, Burm AG. The effects on ventilation of ketorolac in comparison with morphine . Eur J Clin Pharmacol . 1988;35: 491-494.Crossref 45. Yee MK, Evans WD, Facey PE, Hayward MWJ. Gastric empyting and small bowel transit in male volunteers after IM ketorolac and morphine . Br J Anaesth . 1991;67:426-431.Crossref 46. Boras-Uber LA, Brackett NC. Ketorolac-induced acute renal failure . Am J Med . 1992:92:450-452.Crossref 47. Fleming BM, Coombs DW. Bleeding diathesis after perioperative ketorolac . Anesth Analg . 1991;73:232-239.Crossref 48. Greer IA. Effects of ketorolac tromethamine on hemostasis . Pharmacotherapy . 1990;10:71S-76S. 49. Toon S, Holt BL, Mullins FG, Bullingham R, Aarons L, Rowland M. Investigations into the potential effects of multiple dose ketorolac on the pharmacokinetics and pharmacodynamics of racemic warfarin . Br J Clin Pharmacol . 1990; 30:743-750.Crossref 50. Kumar A, Rao M, Kulkarni D. Zinc incorporation reverses suppressant effect of ibuprofen on wound healing . Indian J Exp Biol . 1988;26:483-485. 51. Proper SA, Fenske NA, Burnett SM, Luria LW. Compromised wound repair caused by perioperative use of ibuprofen . J Am Acad Dermatol . 1988;18:1173-1179.Crossref 52. Dahners LE, Gilbert JA, Lester GE, Taft TN, Payne LZ. The effect of a nonsteroidal anti-inflammatory drug on the healing of ligaments . Am J Sports Med . 1988;16:641-646.Crossref 53. Mastboom WJ, Hendriks T, van Elteren EP, deBoer BH. The influence of NSAIDs on experimental intestinal anastomoses . Dis Colon Rectum . 1991;34:236-243.Crossref 54. Faist E, Ertel W, Cohnert T, Huber P, Inthorn D, Heberer G. Immunoprotective effects of cyclooxygenase inhibition in patients with major surgical trauma . J Trauma . 1990;30:8-18.Crossref 55. Veith RC, Best JD, Halter JB. Dose-dependent suppression of norepinephrine appearance rate in plasma by clonidine in man . J Clin Endocrinol Metab . 1984; 59:151-155.Crossref 56. Flacke JW, Bloor BC, Flacke WE, et al. Reduced narcotic requirement by clonidine with improved hemodynamic and adrenergic stability in patients undergoing coronary bypass surgery . Anesthesiology . 1987;67:11-19.Crossref 57. Engelman E, Lipszyc M. Gilbart E. Effects of clonidine on anesthetic requirements and hemodynamic response during aortic surgery . Anesthesiology . 1989; 71:178-187.Crossref 58. Ghignone N, Calvillo O, Quintin L. Anesthesia and hypertension: the effect of clonidine on preoperative hemodynamics and isoflurane requirements . Anesthesiology . 1987;67:3-10.Crossref 59. Ghignone M, Quintin L, Duke PC, Kehler CH, Calvillo O. Effects of clonidine on narcotic requirements and hemodynamic response during induction of fentanyl anesthesia and endotracheal intubation . Anesthesiology . 1986:64:36-42.Crossref 60. Maze M, Tranquilli W. Defining the role of clinical anesthesia . Anesthesiology . 1991;74:581-605.Crossref 61. Gordh T. Epidural clonidine for treatment of postoperative pain after thoractomy: a double-blind placebo-controlled study . Acta Anaesthesiol Scand . 1988; 32:702-709.Crossref 62. Glynn C, Dawson D, Sanders R. A double-blind comparison between epidural morphine and epidural clonidine in patients with chronic non-cancer pain . Pain . 1988;34:123-128.Crossref 63. Kalia PK, Madan R, Batra RK, Latha V, Vardhan V, Gode GR. Clinical study on epidural clonidine for postoperative analgesia . Indian J Med Res . 1986;83:550-552. 64. Bonnet F, Boico O, Rostaing S, et al. Postoperative analgesia with extradural clonidine . Br J Anaesth . 1989;63:465-469.Crossref 65. Lund C, Qvitzau S, Greulich A, Hjortso NC, Kehlet H. Comparison of the effects of extradural clonidine with those of morphine on postoperative pain, stress responses, cardiopulmonary function and motor and sensory block . Br J Anaesth . 1989;63:516-519.Crossref 66. Bonnet F, Boico O, Rostaing S, Loriferne J-F, Saada M. Clonidine-induced analgesia in postoperative patients: epidural versus intramuscular administration . Anesthesiology . 1990;72:423-427.Crossref 67. Eisenach J, Lysak S, Viscomi C. Epidural clonidine analgesia following surgery: phase I . Anesthesiology . 1989;71:640-646.Crossref 68. Filos K, Goudas L, Patroni O, Polyzou V. Intrathecal clonidine as a sole analgesic for pain relief after cesarean section . Anesthesiology . 1992;77:267-274.Crossref 69. Tamsen A, Gordh T. Epidural clonidine produces analgesia . Lancet . 1984;2:231-232.Crossref 70. Elsenach J, Rauck R, Buzzanell C, Lysak S. Epidural clonidine analgesia for intractable cancer pain: phase I . Anesthesiology . 1989;71:647-652.Crossref 71. Benhamou D, Beillete Y, Narchi P, Ecoffey C. Ventilatory effects of premedication with clonidine . Anesth Analg . 1991;73:799-803.Crossref 72. Bailey P, Sperry R, Johnson G, Eldredge S, East K, East T. Respiratory effects of clonidine alone and combined with morphine in humans . Anesthesiology . 1991;74:43-48.Crossref 73. Hord AH, Kelly PM. University-based acute pain treatment service . In: Sinatra RS, Hord AH, Ginsberg B, Preble LM, eds. Acute Pain: Mechanisms and Management . St Louis, Mo: Mosby—Year Book Inc; 1992:532-538. 74. Hubbard L. Community-based pain service . In: Sinatra RS, Hord AH, Ginsberg B, Preble LM, eds. Acute Pain: Mechanisms and Management . St Louis, Mo: Mosby—Year Book Inc; 1992:539-551.
TI - Postoperative Pain Management
JF - Archives of Surgery
DO - 10.1001/archsurg.1994.01420260014002
DA - 1994-02-01
UR - https://www.deepdyve.com/lp/american-medical-association/postoperative-pain-management-PM9dAe1A7K
SP - 128
EP - 132
VL - 129
IS - 2
DP - DeepDyve
ER -