Safety Aspects of Postoperative Pain Management

Authors: Tan, Tee Yong¹; Schug, Stephan A.²

Source: Reviews in Analgesia, Volume 9, Number 1, 2006 , pp. 45-53(9)

Publisher: Cognizant Communication Corporation

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Abstract:

Acute pain after surgery remains poorly managed despite many advances in its treatment. Limitations of its efficacy include safety concerns about the side effects associated with the use of the different analgesics and techniques. The use of multimodal analgesia has become a cornerstone in the management of acute postoperative pain and thereby renewed interest in the widespread use of nonopioids to provide postoperative analgesia. This review focuses on the safety aspects of nonopioids and patient-controlled and epidural analgesia. With appropriate use, acetaminophen is by far the safest and most cost-effective nonopioid analgesic that is available in clinical practice. Major safety concerns focus on hepatotoxicity in relative overdoses. Nonselective NSAIDs and selective coxibs are also effective postoperative analgesics and important components of multimodal analgesia. The current debate on the cardiovascular safety of these compounds in long-term use has clouded the discussion of other areas of concern; overall, coxibs offer a number of safety advantages over NSAIDs in the postoperative setting. Patient-controlled administration of systemic opioids is in general safe, but requires attention to “patient/disease”- and “technique/equipment”related factors to improve safety of the technique. Epidural analgesia carries inherent risks and the increasing perioperative use of modern anticoagulants will require careful consideration in the future. From an organizational point of view, Acute Pain Services with well-trained personnel and established standard operating procedures are the best way to minimize the potential hazards of modern postoperative analgesia.

Keywords: Nonsteroidal anti-inflammatory drugs (NSAIDs); COX-2 inhibitors (Coxibs); Acetaminophen (paracetamol); Patient-controlled analgesia (PCA); Epidural analgesia; Safety; Postoperative pain

Document Type: Research article

Affiliations: 1: Department of Anaesthesia and Pain Medicine, Royal Perth Hospital GPO Box X 2213, Perth, WA 6847, Australia 2: UWA Anaesthesia, School of Medicine and Pharmacology, University of Western Australia, Perth, WA 6847, Australia

Publication date: 2006-01-01

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Previously published as Analgesia

Safety Aspects of Postoperative Pain Management

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