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Acute Perioperative Pain: Mechanisms and Management

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Abstract

Tissue trauma, including from acute trauma, acute surgical pathology, and surgical intervention, typically results in pain as a natural consequence. With an improved understanding of pain genesis, pathways, and pharmacology, much of the pain from surgery can be can usually be minimized or alleviated with adequate planning, consideration, and utilization of a multimodality approach. The aim of this chapter is to explain the principles of acute and chronic pain in the perioperative period and to assist with a better understanding for more effective pain control in surgical practice.

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Further Reading, References and Resources

  • Aasvang E, Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth. 2005;95:69–76.

    CAS  PubMed  Google Scholar 

  • Aasvang EK, Kehlet H. Effect of mesh removal and selected neurectomy on persistent post herniorrhaphy pain. Ann Surg. 2009;249(2):327–34.

    PubMed  Google Scholar 

  • Abraham RB, Marouani N, Weinbroum AA. Dextromethorphan mitigates phantom pain in cancer amputees. Ann Surg Oncol. 2003;10:268–74.

    PubMed  Google Scholar 

  • Adami S, Fossaluzza V, Gatti D, Fracassi E, Braga V. Bisphosphonate therapy of reflex sympathetic dystrophy syndrome. ANN Rheum Dis. 1997;56:201–4.

    CAS  PubMed  Google Scholar 

  • Ahn H, Bronge A, Johansson K, Ygge H, Lindhagen J. Effect of continuous epidural analgesia on gastro-intestinal motility. Br J Surg. 1988;75:1176–8.

    CAS  PubMed  Google Scholar 

  • Andrew J. Recovery from surgery with and without preparation instruction, for three coping styles. J Pers Soc Psychol. 1970;17:233.

    Google Scholar 

  • Applegate WV. Abdominal cutaneous nerve entrapment syndrome. Surgery. 1972;71:118.

    CAS  PubMed  Google Scholar 

  • Binder A, Baron R. Complex regional pain syndrome, including applications of neural blockade. In: Cousins MJ, Carr DB, Horlocker T, Bridenbaugh PO, editors. Neural blockade in clinical anesthesia and pain medicine. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2009. p. 1154–68.

    Google Scholar 

  • Bisgaard T, Klarskov B, Rosendbeerg J, Kehlet H. Characteristics and predictors of early pain after laparoscopic cholecystectomy. Pain. 2001;90:261.

    CAS  PubMed  Google Scholar 

  • Bone M, Critchley P, Buggy DJ. Gabapentin in postamputation phantom limb pain: a randomized, double blind placebo controlled, cross-over study. Reg Anaesth Pain Manage. 2002;27:481–6.

    CAS  Google Scholar 

  • Bowler G, Wildsmith J, Scott DB. Epidural administration of local anaesthetics. In: Cousins MJ, Phillips GD, editors. Acute pain management. New York: Churchill Livingstone; 1986. p. 187–236.

    Google Scholar 

  • Bradner B, Bromley L, Blagrove M. Influence of psychological factors in the use of patient controlled analgesia. Acute Pain. 2002;4:52–6.

    Google Scholar 

  • Brodner G, Pogatzki E, Van Aken H, Buerkle H, Goeters C, Schulzki C, et al. A multimodal approach to control postoperative pathophysiology and rehabilitation in patients undergoing abdominothoracic esophagectomy. Anesth Analg. 1998;86:228–34.

    CAS  PubMed  Google Scholar 

  • Bruehl S, Harden RN, Gaier B, Saltz S, Betram M, Backoja M, et al. External validation if iasp diagnostic criteria for complex regional pain syndrome and proposed research diagnostic criteria. Pain. 1999;81:147–54.

    CAS  PubMed  Google Scholar 

  • Callesen T, Bech K, Kehlet H. Prospective study of chronic pain after groin hernia repair. Br J Surg. 1999;86:528–31.

    Google Scholar 

  • Carli F, Schricker T. Modification of metabolic responses to surgery by neural blockade. In: Cousins MJ, Carr DB, Horlocker T, Bridenbaugh PO, editors. Neural blockade in clinical anesthesia and pain medicine. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2009. p. 133–43.

    Google Scholar 

  • Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Adamatti LC, et al. Preoperative predictors of moderate to intense acute postoperative pain I patients undergoing abdominal surgery. Acta Anaesthesiol Scand. 2002;46:1265–71.

    CAS  PubMed  Google Scholar 

  • Cepeda MS, Lau J, Carr DB. Defining the therapeutic role of local anaesthetic sympathetic blockade in complex regional pain syndrome. A narrative and systematic review. Clin J Pain. 2002;18:216–33.

    PubMed  Google Scholar 

  • Christopherson R, Beattie C, Frank SM, Norris EJ, Meinert CL, Gottlieb SO, et al. The perioperative ischemia randomized anesthesia trial study group: perioperative morbidity in patients randomized to epidural or general anesthesia for lower-extremity vascular surgery. Anesthesiology. 1993;79:422–34.

    CAS  PubMed  Google Scholar 

  • Collingridge G, Singer W. Excitatory amino acid receptors and synaptic plasticity. Trends Pharmacol Sci. 1990;11:290–6.

    CAS  PubMed  Google Scholar 

  • Cousins N. Anatomy of an illness as perceived by the patient. New York: Norton; 1970.

    Google Scholar 

  • Cousins MJ, Brennan F, Carr DB. Editorial pain relief: a universal human right. Pain. 2004;112:1–4.

    PubMed  Google Scholar 

  • Dahl JB, Rosenberg J, Dirkes WE, Morgensen T, Kehlet H. Prevention of postoperative pain by balanced analgesia. Br J Anaesth. 1990;64:518–20.

    CAS  PubMed  Google Scholar 

  • Davies SN, Lodge D. Evidence for involvement of N-methylaspartate receptors in ‘wind-up’ of class 2 neurons in the dorsal horn of the rat. Brain Res. 1987;424:402–6.

    CAS  PubMed  Google Scholar 

  • Dickenson AH. NMDA receptor antagonists as analgesics. In: Fields HL, Liebeskind JC, editors. Pharmacological approaches to the treatment of chronic pain: concepts and critical issues. Progress in pain research and management, vol. 1. Seattle: IASP Press; 1996. p. 173–87.

    Google Scholar 

  • Dimatteo MR, Di Nicola DD. Achieving patient compliance: the psychology of the medical practitioner’s role. New York: Pergamon Press; 1982.

    Google Scholar 

  • Eisenach JC. Aspirin, the miracle drug – spinally, too? Anesthesiology. 1993;79:211–13.

    CAS  PubMed  Google Scholar 

  • Flor H, Denke C, Schaefer M, Grüsser S. Sensory discrimination training alters both cortical reorganisation and phantom limb pain. Lancet. 2001;357:1763–4.

    CAS  PubMed  Google Scholar 

  • Garthwaite J, Charles SL, Chess-Williams R. Endothelium-derived relaxing factor release on activation of NMDA receptors suggests role as intercellular messenger in the brain. Nature. 1988;336:385–8.

    CAS  PubMed  Google Scholar 

  • Grant AM, Scott NW, O’Dwyer PJ, MRC Laparoscopic Groin Hernia Trial Group. Five year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg. 2004;91:1570074.

    Google Scholar 

  • Groudine SB, Fisher HAG, Kaufman Jr RP, Patel MK, Wilkins LJ, Mehta SA, et al. Intravenous lidocaine speeds the return of bowel function, decreases postoperative pain, and shortens hospital stay in patients undergoing radical retropubic prostatectomy. Anesth Analg. 1998;86:235–9.

    CAS  PubMed  Google Scholar 

  • Halbert J, Crotty M, Cameron ID. Evidence for the optimal management of acute and chronic phantom pain: a systematic review. Clin J Pain. 2002;18:84–92.

    PubMed  Google Scholar 

  • Hanley MA, Jensen MP, Ehde DM, Hoffman AJ, Patterson R, Robinson LR. Psychosocial predictors of long-term adjustment to lower-limb amputation and phantom limb pain. Disabil Rehabil. 2004;26:882–93.

    PubMed  Google Scholar 

  • Harden RN, Bruehl S, Galer BS, Saltz S, Bertram M, Backonja M, Gayles R, Rudin N, Bhugra MK, Stanton-Hicks M. Complex regional pain syndrome: are the IASP diagnostic criteria valid and sufficiently comprehensive? Pain. 1999;83(2):211–9.

    CAS  PubMed  Google Scholar 

  • Hoar PF, Hickey RF. Systemic hypertension following myocardial revascularization: a method of treatment using epidural anesthesia. J Thorac Cardiovasc Surg. 1976;71:859.

    CAS  PubMed  Google Scholar 

  • Jacobsen PB, Butler RW. Relation of cognitive coping and catastrophizing to acute pain and analgesia after breast surgery. J Behav Med. 1996;19:17–29.

    CAS  PubMed  Google Scholar 

  • Jaeger H, Maier C. Calcitonin in phantom limb pain: a double blind study. Pain. 1992;48:21–7.

    CAS  PubMed  Google Scholar 

  • Jensen TS, Krebs B, Neilsen J, Rasmussen P. Immediate and long term phantom limb pain in amputees: incidence, clinical characteristics and relationship to pre-amputation limb pain. Pain. 1985;21:267–78.

    CAS  PubMed  Google Scholar 

  • Johnson M. Anxiety in surgical patients. Psychol Med. 1980;10:145.

    Google Scholar 

  • Jorgensen L, Rasmussen L, Nielsen A, Leffers A, Albrecht-Beste E. Antithrombotic efficacy of continuous extradural analgesia after knee replacement. Br J Anaesth. 1991;66:8–12.

    CAS  PubMed  Google Scholar 

  • Katz J, Melzack R. Psychological aspects of pain: implications for neural blockade. In: Cousins MJ, Carr DB, Horlocker T, Bridenbaugh PO, editors. Neural blockade in clinical anesthesia and pain medicine. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2009. p. 777–93.

    Google Scholar 

  • Katz J, Jackson M, Kavanagh BP, Sandler AN. Acute pain after thoracic surgery predicts long-term post-thoracotomy pain. Clin J pain. 1996;12:50–5.

    CAS  PubMed  Google Scholar 

  • Kehlet H. The modifying effect of general and regional anesthesia on the endocrine-metabolic response to surgery. Reg Anesth. 1982;7:538.

    Google Scholar 

  • Kehlet H. The stress response to surgery: release mechanisms and the modifying effects of pain relief. Acta Chir Scand Suppl. 1989;55:22–33.

    Google Scholar 

  • Kehlet H. Modification of responses to surgery by neural blockade. In: Cousins MJ, Bridenbaugh PO, editors. Neural blockade in clinical anesthesia and management of pain. 3rd ed. Philadelphia: Lippincott; 1998. p. 129–75.

    Google Scholar 

  • Kehlet H. The role of the anaesthesiologist in fast-track surgery. Anesth Analg. 2008;106(Suppl):53–6.

    Google Scholar 

  • Kehlet H, Dahl JB. The value of ‘multimodal’ or ‘balanced analgesia’ in postoperative pain treatment. Anesth Analg. 1993;77:1048–56.

    CAS  PubMed  Google Scholar 

  • Kehlet H, Rung GW, Callesen T. Postoperative opioid analgesia: time for a reconsideration? J Clin Anesth. 1996;8(6):441–5. Review.

    CAS  PubMed  Google Scholar 

  • Kehlet H. Effect of pain relief on the surgical stress response. Reg Anesth. 1996;21(6 Suppl):35–7. Review.

    CAS  PubMed  Google Scholar 

  • Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248:189–98.

    PubMed  Google Scholar 

  • Kehlet H, Jensen TS, Woolf CS. Postsurgical persistent pain and risk factors and prevention. Lancet. 2006;367:1618–25.

    PubMed  Google Scholar 

  • Kemler MA, Barendse GAM, Van Kleef M, de Vet HC, Rijks CP, Furnée CA, et al. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med. 2000;343:618–24.

    CAS  PubMed  Google Scholar 

  • Kemler MA, De Vet HC, Barendse GA, et al. The effect of spinal cord stimulation in patients with chronic reflex sympathetic dystrophy: two years follow-up of the randomised controlled, trial. Ann Neurol. 2004;55:13–8.

    PubMed  Google Scholar 

  • Kitzinger S. Episiotomy pain. In: Wall PD, Melzack R, editors. Textbook of pain. 1st ed. Edinburgh: Churchill Livingstone; 1984. p. 293–303.

    Google Scholar 

  • Kudoh A, Katagai H, Takazawa T. Increased postoperative pain scores in chronic depression patients who take antidepressants. J Clin Anesth. 2001;14:421–5.

    Google Scholar 

  • Kumar B, Hibbert GR. Control of hypertension during aortic surgery using lumbar extradural blockade. Br J Anesth. 1984;56:797.

    Google Scholar 

  • Levine JD, Fields HL, Basbaum AI. Peptides and the primary afferent nociceptor. J Neurosci. 1993;13:2273–86.

    CAS  PubMed  Google Scholar 

  • Lindblom U. Sensory abnormalities in neuralgia. In: Bonica JJ, Liebeskind JC, Albe-Fessard DL, editors. Advances in pain research and therapy, vol. 3. New York: Raven; 1979. p. 111–20.

    Google Scholar 

  • Litwin MS. Postsympathectomy neuralgia. Arch Surg. 1962;84:591–5.

    Google Scholar 

  • Liu SS, Carpenter RL, Mackey DC, Thirlby RC, Rupp SM, Shine TS, et al. Effects of perioperative analgesic technique on rate of recovery after colon surgery. Anesthesiology. 1995;83:757–65.

    CAS  PubMed  Google Scholar 

  • Liu SS, Carpenter RL, Neal JM. Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology. 1995;82:1474–506.

    CAS  PubMed  Google Scholar 

  • Lotze M, Grodd W, Birbaumer N, Erb M, Huse E, Flor H, et al. Does use of myoelectric prosthesis reduce cortical reorganisation and phantom limb pain. Nat Neurosci. 1999;2:501502.

    Google Scholar 

  • Macintyre PE, Schug SA. Acute pain management: a practical guide. 3rd ed. Edinburgh/New York: Elsevier; 2007. ISBN 9780702027703.

    Google Scholar 

  • Macrae WA. Chronic pain after surgery. Br J Anaesth. 2001;87:88–98.

    CAS  PubMed  Google Scholar 

  • Maier C, Dertwinkel R, Mansourian N, Hosbach I, Schwenkreis P, Senne I, et al. Efficacy of the NMDA-receptor antagonist memantine in patients with chronic phantom limb pain- results of a randomised double blinded, placebo controlled trial. Pain. 2003;103:277–83.

    CAS  PubMed  Google Scholar 

  • Malmberg AB, Yaksh TL. Spinal nitric oxide synthesis inhibition blocks NMDA-induced thermal hyperalgesia and produces antinociception in the formalin test in rats. Pain. 1993;54:291–300.

    CAS  PubMed  Google Scholar 

  • McCartney CJ, Sinha A, Katz J. A qualitative systematic review of the role of N-methyl-D-aspartate receptor antagonists in preventative analgesia. Anaesth Analg. 2004;98:1385–400.

    CAS  Google Scholar 

  • McLachlan EM, Jänig W, Devor M, Michaelis M. Peripheral nerve injury triggers noradrenergic sprouting within dorsal root ganglia. Nature. 1993;363:543–6.

    CAS  PubMed  Google Scholar 

  • Meller ST, Gebhart GF. Nitric oxide (NO) and nociceptive processing in the spinal cord. Pain. 1993;52:127–36.

    CAS  PubMed  Google Scholar 

  • Melzack R. Pain: past, present and future. Can J Exp Psychol. 1993;47(4):615–29.

    CAS  PubMed  Google Scholar 

  • Melzack R, Wall PD. The challenge of pain. 2nd ed. London: Penguin Books; 1988.

    Google Scholar 

  • Merskey H. Pain terms: a list with definitions and notes on usage. Recommended by the subcommittee on taxonomy. Pain. 1979;6:249–52.

    Google Scholar 

  • Merskey H, Bogduk N. Classification of chronic pain: description of chronic pain syndromes and definitions of pain terms. 2nd ed. Seattle: IASP Press; 1994. p. 209–314.

    Google Scholar 

  • Moiniche S, Hjortso NC, Hansen BL, Dahl JB, Rosenberg J, Gebuhr P, et al. The effect of balanced analgesia on early convalescence after major orthopaedic surgery. Acta Anaesthesiol Scand. 1994;38:328–35.

    CAS  PubMed  Google Scholar 

  • Moiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of pre-emptive analgesia for post-operative pain relief- the role of timing of analgesia. Anaesthesiology. 2002;96:725–41.

    Google Scholar 

  • Morgan JI, Curran T. Role of ion flux in the control of c-fos expression. Nature. 1986;322:552–5.

    CAS  PubMed  Google Scholar 

  • Nelson FV, Zimmerman L, Baranson S, Nieveen J, Schmaderer M, et al. The relationship and influence of anxiety on post-operative pain in the coronary artery bypass patient. J Pain Symptom Manage. 1998;15:102–9.

    CAS  PubMed  Google Scholar 

  • NHMRC. Acute pain management: scientific evidence. Canberra: National Health and Medical Research Council of Australia; 1999.

    Google Scholar 

  • NHMRC (National Health and Medical Research Council of Australia) Acute pain management: scientific evidence. Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine (June 2005). Australian and New Zealand College of Anaesthetists; 2005 ISBN Print: 0-9585208-6-0 Online: 0-9585208-7-9. www.anzca.edu.au/resources/books-and-publications

  • NHMRC (National Health and Medical Research Council of Australia) Acute pain management: scientific evidence. Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine, (New Version late 2009). Australian and New Zealand College of Anaesthetists; 2009 ISBN Print. www.anzca.edu.au/resources/books-and-publications

  • Nikolajsen L, Hansen CL, Neilsen J, Keller J, Arendt-Nielsen L, Jensen TS. The effect of ketamine on phantom limb pain: a central neuropathic disorder maintained by peripheral input. Pain. 1996;67:69–77.

    CAS  PubMed  Google Scholar 

  • Nikolajsen L, Ilkjaer S, Kroner K, Christensen JH, Jensen TS. The influence of preamputation pain on postamputation stump and phantom pain. Pain. 1997;72:3930495.

    Google Scholar 

  • O’Dwyer PJ, Kingsnorth AN, Molloy RG, Small PK, Lammers B, Horeyseck G. Randomised clinical trial assessing impact of a lightweight or heavyweight mesh on chronic pain after inguinal hernia repair. Br J Surg. 2005;92:166–70.

    PubMed  Google Scholar 

  • Ong CK, Lirk P, Seymour RA, Jenkins BJ. The efficacy of pre-emptive analgesia for acute post-operative pain management: a Meta-Analysis. Anaesth Analg. 2005;100:757–73.

    Google Scholar 

  • Pavlin JD, Sullivan MJL, Freund PR, Roesen K. Catastrophising: a risk factor for postsurgical pain. Clin J Pain. 2005;21:83–90.

    PubMed  Google Scholar 

  • Peck C. Psychological factors in acute pain management. In: Cousins MJ, Phillips GD, editors. Acute pain management. Edinburgh: Churchill Livingstone; 1986. p. 251–74.

    Google Scholar 

  • Perkins F, Kehlet H. Chronic pain as an outcome of surgery. A review of predictive factors. Anaesthesiology. 2000;93:1123–33.

    CAS  Google Scholar 

  • Prager JP, Stanton-Hicks M. Neurostimulation. In: Cousins MJ, Carr DB, Horlocker T, Bridenbaugh PO, editors. Neural blockade in clinical anesthesia and pain medicine. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2009. p. 948–90.

    Google Scholar 

  • Ramachandran VS, Rogers-Rmachandran D. Phantom limbs and neural plasticity. Arch Neurol. 2000;57:317–20.

    CAS  PubMed  Google Scholar 

  • Scheinin B, Asantila R, Orko R. The effect of bupivacaine and morphine on pain and bowel function after colonic surgery. Acta Anaesthesiol Scand. 1987;31:161–4.

    CAS  PubMed  Google Scholar 

  • Schulze S, Roikjaer O, Hasseistrom L, Jensen NH, Kehlet H. Epidural bupivacaine and morphine plus systemic indomethacin eliminates pain but not systemic response and convalescence after cholecystectomy. Surgery. 1988;103:321–7.

    CAS  PubMed  Google Scholar 

  • Scott N, Kehlet H. Regional anaesthesia and surgical morbidity. Br J Surg. 1988;75:199–204.

    Google Scholar 

  • Senturk M, Ozcan PE, Talu GK, Kiyan E, Camci E, Ozyalçin S, et al. The effects of three different analgesia techniques on long-term post thoracotomy pain. Anaesth Analg. 2002;94:11–5.

    Google Scholar 

  • Shipton E. Post-surgical neuropathic pain. ANZJ Surg. 2008;78:548–55.

    Google Scholar 

  • Siddall PJ, Cousins MJ. Introduction to acute and chronic pain. In: Cousins MJ, Carr DB, Horlocker T, Bridenbaugh PO, editors. Neural blockade in clinical anesthesia and pain medicine. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2009. p. 661–92.

    Google Scholar 

  • Sjogren S, Wright B. Circulatory changes during continuous epidural blockade. Acta Anaesthesiol Scand. 1972;46(Suppl):5.

    CAS  Google Scholar 

  • Tasker RR, Tsuda T, Hawrylyshyn P. Clinical neurophysiological investigation of deafferentation pain. In: Bonica JJ, Lindblom U, Iggo A, editors. Advances in pain research and therapy, vol. 5. New York: Raven; 1983. p. 713–38.

    Google Scholar 

  • Tasmuth T, Estlanderb AM, Kalso E. Effect of present pain and mood on the memory of past post-operative pain in women treated surgically for breast cancer. Pain. 1996;68:343–7.

    CAS  PubMed  Google Scholar 

  • Tegeder I, Costigan M, Griffin RS, Abele A, Belfer I, et al. GTP cyclohydrolase and tetrahydrobiopterin regulate pain sensitivity and persistence. Nat Med. 2006;12:1269–77.

    CAS  PubMed  Google Scholar 

  • Thoren T, Sundberg A, Wattwil M, Garvill JE, Jürgensen U. Effects of epidural bupivacaine and epidural morphine on bowel function and pain after hysterectomy. Acta Anaesthesiol Scand. 1989;33:181–95.

    CAS  PubMed  Google Scholar 

  • Thorn SE, Wattwil M, Naslund I. Post-operative epidural morphine but not epidural bupivacaine, delays gastric emptying on the first day after cholecystectomy. Reg Anesth. 1992;17(2):91–4.

    CAS  PubMed  Google Scholar 

  • Vareena M, Zucchi F, Ghiringhelli D, Binelli L, Bevilacqua M, Bettica P, et al. Intravenous clodronate in the treatment of reflex sympathetic dystrophy. A randomised, double blind, placebo controlled study. J Rheumatol. 2000;27:1477–83.

    Google Scholar 

  • Voudoris N, Peck C. Conditional placebo responses. J Pers Soc Psychol. 1985;48:47.

    Google Scholar 

  • Wartan SW, Hamman W, Wedley JR, McColl I. Phantom pain and sensation among British veteran amputees. Br J Anaesth. 1997;78:652–9.

    CAS  PubMed  Google Scholar 

  • Wattwil M, Thoren T, Hennerdal S, Garvill JE. Epidural analgesia with bupivacaine reduces postoperative paralytic ileus after hysterectomy. Anesth Analg. 1989;68:353–8.

    CAS  PubMed  Google Scholar 

  • Weich K, et al. Prevention of phantom limb pain and cortical reorganisation in the early phase after amputation in humans. Soc Neurosci Abstr. 2001;28:163–9.

    Google Scholar 

  • White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg. 2005;101:S5–22. Review.

    PubMed  Google Scholar 

  • White JC, Sweet WH. Pain and the neurosurgeon. Springfield: CC Thomas; 1962. p. 11–49.

    Google Scholar 

  • Woolf CJ. Evidence for a central component of post injury pain hypersensitivity. Nature. 1983;306:686–8.

    CAS  PubMed  Google Scholar 

  • Woolf CJ, Manion RJ. Pain: neuropathic pain: aetiology, symptoms, mechanisms and management. Lancet. 1999;35:1959–64.

    Google Scholar 

  • Woolf CJ, Thompson SWN. The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain. 1991;44:293–9.

    CAS  PubMed  Google Scholar 

  • Wu CL, Liu SS. Neural blockade: impact on outcome. In: Cousins MJ, Carr DB, Horlocker T, Bridenbaugh PO, editors. Neural blockade in clinical anesthesia and pain medicine. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2009. p. 144–58.

    Google Scholar 

  • Wu CL, Tella P, Staats PS, Vaslav R, Kazim DA, Wesselmann U, et al. Analgesic effects of intravenous lidocaine and morphine on postamputation pain. Anaesthesiology. 2002;96:8410–848.

    Google Scholar 

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Acknowledgments

The authors would like to thank the Australian and New Zealand College of Anaesthetists and Dr. Pam Macintyre, Director, Acute Pain Service Royal Adelaide Hospital, for the invaluable resources they have provided to the public and medical community.

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Cousins, M.J., Emmanuel, J., Coventry, B.J. (2014). Acute Perioperative Pain: Mechanisms and Management. In: Coventry, B. (eds) General Surgery Risk Reduction. Surgery: Complications, Risks and Consequences. Springer, London. https://doi.org/10.1007/978-1-4471-5391-7_7

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