Optimizing perioperative analgesia for the complex pain patient: medical and interventional strategies

Review Article/Brief Review

Abstract

Purpose

The purpose of this article is to review the literature and to highlight current practice regarding the management of the chronic pain patient presenting for surgery.

Principal findings

It can be difficult to achieve adequate postoperative analgesia in patients who present for surgery with preexisting chronic pain. Such complex pain patients require a care plan that involves preoperative, intraoperative, and postoperative considerations. Preoperatively, it is important to identify these patients’ specific concerns, to address anxiety, to review expectations of care, and to consider premedication. Intraoperatively, it is important to consider local anesthetic regional anesthesia techniques and to supplement as necessary with pharmaceutical agents, e.g., ketamine, dexamethasone, ketorolac, and opioids. Postoperatively, it is important to continue multimodal analgesia techniques. It is vital to maintain a healthy therapeutic alliance with the patient and with allied health professionals. Nonspecific treatment effects can bolster efforts to achieve adequate analgesia.

Conclusion

Successful management of the complex pain patient requires knowledge of the art and science of perioperative medicine.

L’optimisation de l’analgésie périopératoire du patient avec douleurs complexes: stratégies médicales et interventionnelles

Résumé

Objectif

L’objectif de cet article est de passer en revue la littérature et de souligner la pratique actuelle concernant la prise en charge du patient souffrant de douleur chronique et se présentant pour une chirurgie.

Constatations principales

Il peut être difficile de réaliser une analgésie postopératoire adaptée chez les patients se présentant pour une chirurgie mais souffrant de douleur chronique préexistante. Ces patients avec douleurs complexes ont besoin d’un plan de soins qui tienne compte de considérations pré-, per- et postopératoires. En période préopératoire, il est important d’identifier les préoccupations spécifiques de ces patients, de tenir compte de leur anxiété, de passer en revue leurs attentes en matière de soins et d’envisager une prémédication. En période peropératoire, il est important d’envisager des techniques d’anesthésie régionale utilisant des anesthésiques locaux et de les supplémenter, au besoin, avec des agents pharmaceutiques tels que la kétamine, la dexaméthasone, le kétorolac et les opioïdes, par exemple. En période postopératoire, il est important de poursuivre les techniques d’analgésie multimodales. Il est essentiel de maintenir une alliance thérapeutique saine aussi bien avec les patients qu’avec le personnel paramédical. Des effets non spécifiques d’un traitement peuvent soutenir les efforts pour obtenir une analgésie adaptée.

Conclusion

La prise en charge réussie du patient avec douleurs complexes nécessite des connaissances concernant l’art et la science de la médecine périopératoire.

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Copyright information

© Canadian Anesthesiologists' Society 2013

Authors and Affiliations

  1. 1.University Health Network and Wasser Pain Centre, Mt. Sinai Hospital, University of TorontoTorontoCanada

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