Skip to main content
SpringerLink
Log in

Multimodal Analgesic Plans for Cancer Surgeries

  • Chapter
  • First Online:
Multidisciplinary Approach to Surgical Oncology Patients

  • 484 Accesses

Abstract

Pain is recognized as fifth vital sign. Optimal perioperative pain management not only improves overall surgical outcome but also improves patient satisfaction [1]. This requires adequate assessment preoperatively, a proper plan for pain relief and its execution during the surgical intervention which continues in the postoperative period. A prior discussion with patients allays anxiety and fear of pain for the surgical intervention. In the recent era, advancement in the surgical techniques has led to more invasive to lesser invasive like endoscope or laparoscopically assisted procedures. This has a benefit of lesser tissue trauma and thus lesser pain. On the other hand, the number of complex procedures has increased and thus need for proper planning and execution of pain management is essential. The pain management is an essential responsibility for the anesthesiologist; however, understanding the basic concepts of pain management would help the surgeons in accomplishing an effective perioperative pain management. The key to success for pain relief is to create a fine balance by judicious usage of the wide array of pain relief modalities and newer analgesic agents, thus avoiding both under- and over-treatment and creating a pain-free experience for the patient.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Bonnet F, Marret E. Postoperative pain management and outcome after surgery. Best Pract Res Clin Anaesthesiol. 2007;21:99–107.

    Article  Google Scholar 

  2. Arntz A, Claassens L. The meaning of pain influences its experienced intensity. Pain. 2004;109:20–5.

    Article  Google Scholar 

  3. Middleton C. Understanding the physiological effects of unrelieved pain. Nurs Times. 2003;99(37):28–31.

    PubMed  Google Scholar 

  4. Woolf CJ, Ma Q. Nociceptors – noxious stimulus detectors. Neuron. 2007;55:353–64.

    Article  CAS  Google Scholar 

  5. Harris FD. Some physiological aspects of referred pain. Can Med Assoc J. 1912;2:309–19.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Purves D, Augustine GJ, Fitzpatrick D. The major afferent pathway for mechanosensory information: the dorsal column-medial lemniscus system. In: Purves D, Augustine GJ, Fitzpatrick D, et al., editors. Neuroscience. 2nd ed. Sunderland, MA: Sinauer Associates; 2001.

    Google Scholar 

  7. Valley MA. Pain measurement. In: Raj PP, editor. Pain medicine: a comprehensive review. Mosby: St Louis; 1996. p. 36–45.

    Google Scholar 

  8. Keela AH, Garand LRN. Assessment and measurement of pain in older adults. Clin Geriatr Med. 2001;17(3):457–vi.

    Article  Google Scholar 

  9. Cohen LL, Lemanek K, Blount RL, Dahlquist LM, et al. Evidence based assessment of pediatric pain. J Pediatr Psychol. 2008;33:939–55.

    Article  Google Scholar 

  10. Nadler SF. Nonpharmacologic management of pain. J Am Osteopath Assoc. 2004;104(11 Suppl 8):S6–12.

    PubMed  Google Scholar 

  11. 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. 2004;100:1573–81.

    Article  Google Scholar 

  12. Staahl C, Olesen AE, Andresen T, Lars A-N, Drewes AM. Assessing efficacy of non-opioid analgesics in experimental pain models in healthy volunteers: an updated review. Br J Clin Pharmacol. 2009;68:322–41.

    Article  CAS  Google Scholar 

  13. Hinz B, Brune K. Antipyretic analgesics: non-steroidal antiinflammatory drugs, selective COX-2 inhibitors, paracetamol and pyrazolinones. Handb Exp Pharmacol. 2007;177:65–93.

    Article  CAS  Google Scholar 

  14. Horlocker TT, Wedel DJ, Benzon H, et al. Regional anesthesia in the anticoagulated patient: defining the risks. Reg Anesth Pain Med. 2003;28:171–85.

    Google Scholar 

  15. Forster JG, Rosenberg PH, Niemi TT. Continuous spinal microcatheter (28G) technique for arterial bypass surgery of the lower extremities and comparison of ropivacaine with or without morphine for postoperative analgesia. Br J Anaesth. 2006;97:393–404.

    Article  CAS  Google Scholar 

  16. Conacher ID, Slinger PD. Pain management. In: Kaplan J, Slinger P, editors. Thoracic anesthesia. 3rd ed. Philadelphia: Churchill Livingstone; 2003.

    Google Scholar 

  17. Minzter B, Grimm BJ, Johnson RF. The practice of thoracic epidural analgesia: a survey of academic medical centers in the United States. Anesth Analg. 2002;95:472–82.

    PubMed  Google Scholar 

  18. Ramsay MAE. Acute postoperative pain management. Proc (Bayl Univ Med Cent). 2000;13:244–7.

    Article  CAS  Google Scholar 

  19. Swegle JM, Logemann C. Management of common opioid-induced adverse effects. Am Fam Physician. 2006;74:1347–54.

    PubMed  Google Scholar 

  20. Shin S, Min KT, Shin YS, Joo HM, Yoo YC. Yonsei Med J. 2014;55:800–6.

    Article  Google Scholar 

  21. Devaux C, Schoepffler P, Gauthier-Lafaye JP. Side-effects of mixed agonist-antagonist analgesics used in sequential anaesthesia. Br J Clin Pharmacol. 1979;7(Suppl 3):323S–6S.

    Article  Google Scholar 

  22. Lui F, Ng KF. Adjuvant analgesics in acute pain. Expert Opin Pharmacother. 2011;12:363–72.

    Article  CAS  Google Scholar 

  23. Eisenach JC, De Kock M, Klimscha W. Alpha-2-adrenergic agonists for regional anesthesia : a clinical review of clonidine (1984-1995). Anesthesiology. 1996;85:655–66.

    Article  CAS  Google Scholar 

  24. Visser E, Schug SA. The role of ketamine in pain management. Biomed Pharmacother. 2006;60:341–8.

    Article  CAS  Google Scholar 

  25. Marhofer P, Chan VW. Ultrasound-guided regional anesthesia: current concepts and future trends. Anesth Analg. 2007;104:1265–9.

    Article  Google Scholar 

  26. Schafhalter-Zoppoth I, McCulloch CE, Gray AT. Ultrasound visibility of needles used for regional nerve block: an in vitro study. Reg Anesth Pain Med. 2004;29:480–8.

    Article  Google Scholar 

  27. Vadivelu N, Mitra S, Narayan D. Recents advances in postoperative pain management. Yale J Biol Med. 2010;83(1):11–25.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Rigg JRA, Jamrozik K, Myles P, et al. Epidural anaesthesia and analgesia and outcome of major surgery : a randomized trial. Lancet. 2002;359:1276.

    Article  Google Scholar 

  29. Macintyre PE, Jarvis DA. Age is the best predictor of postoperative morphine requirements. Pain. 1996;64:357–64.

    Article  CAS  Google Scholar 

  30. Kumar A, Sharma DK, Datta B. Addition of ketamine or dexmedetomidine to lignocaine in intravenous regional anesthesia: a randomized controlled study. J Anaesthesiol Clin Pharmacol. 2012;28:501–4.

    Article  CAS  Google Scholar 

  31. Mayes S, Ferrone M. Fentanyl HCl patient-controlled iontophoretic transdermal system for the management of acute postoperative pain. Ann Pharmacother. 2006;40:2178–86.

    Article  CAS  Google Scholar 

  32. Grosu I, Lavand’homme P. Use of dexmedetomidine for pain control. F1000 Med Rep. 2010;2:90.

    Article  Google Scholar 

  33. Meissner W. The role of acupuncture and transcutaneous-electrical nerve stimulation for postoperative pain control. Curr Opin Anaesthesiol. 2009;22:623–6.

    Article  Google Scholar 

  34. Hariharan U, Garg R. Update on opioid addiction for perioperative and critical unit care: anaesthesiologists perspective. J Addict Med Ther Sci. 2015;2:107.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Onco-Anaesthesiology, Critical Care, Pain and Palliative Medicine, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India

    Rakesh Garg

  2. Department of Anaesthesiology, Ram Manohar Lohia Hospital, New Delhi, India

    Uma Hariharan

Authors
  1. Rakesh Garg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Uma Hariharan
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India

    M. D. Ray

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Garg, R., Hariharan, U. (2021). Multimodal Analgesic Plans for Cancer Surgeries. In: Ray, M.D. (eds) Multidisciplinary Approach to Surgical Oncology Patients. Springer, Singapore. https://doi.org/10.1007/978-981-15-7699-7_11

Download citation

  • DOI: https://doi.org/10.1007/978-981-15-7699-7_11

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-7698-0

  • Online ISBN: 978-981-15-7699-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation