Skip to main content

Advertisement

SpringerLink
Log in

Postoperative pain

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Treatment of postoperative pain has not received sufficient attention by the surgical profession. Recent developments concerned with acute pain physiology and improved techniques for postoperative pain relief should result in more satisfactory treatment of postoperative pain. Such pain relief may also modify various aspects of the surgical stress response, and nociceptive blockade by regional anesthetic techniques has been demonstrated to improve various parameters of postoperative outcome. It is therefore stressed that effective control of postoperative pain, combined with a high degree of surgical expertise and use of other perioperative therapeutic interventions including nutrition and mobilization, should be combined to improve overall perioperative care and surgical outcome.

Résumé

Le traitement de la douleur post-opératoire n'a pas été suffisement pris en compte jusquà présent par les équipes chirurgicales. Les recherches récentes dans le domaine de la physiologie des douleurs aiguěs et l'amélioration des techniques d'analgésie post-opératoire devraient permettre une meilleure prise en charge de la douleur post-opératoire. Une telle analgésie peut aussi modifier différents aspects de la réponse à l'aggression chirurgicale; ainsi il a été montré que le blocage des stimulations nociceptives par des techniques d'anésthésie régionale améliorait différents paramètres des suites post-opératoires. Il faut donc souligner qu'un contrôle effectif de la douleur post-opératoire, associé à une trés grande expérience chirurgicale et à l'utilisation d'autres moyens thérapeutiques péri-opératoires tels que le support nutritionel et le nursing devrait permettre d'améliorer l'évolution.

Resumen

El manejo del dolor postoperatorio no ha recibido suficiente atención por parte de la profesión quirúrgica. Los recientes desarrollos y avances relativos a la fisiología del dolor agudo y las técnicas avanzadas de control del dolor postoperatorio deben resultar un un manejo bastante más satisfactorio. Tal control del dolor puede también modificar diversos aspectos de la respuesta al etrés quirúrgico, así como el bloqueo que produce la anestesia regional ha demostrado mejorar varios parámetros del resultado postoperatorio. Se hace énfasis, por lo tanto, en que el eficaz control del dolor postoperatorio, en combinación con un alto grado de destreza quirúrgica y el uso de otras intervenciones terapéuticas perioperatorias, como el soporte nutricional y la movilización, deben ser empleados en conjunto para mejorar el cuidado general perioperatoro y el resultado quirúrgico final.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Michell, R.W.D., Smith, G.: The control of acute postoperative pain. Br. J. Anaesth.63:147, 1989

    Google Scholar 

  2. Kuhn, S., Cooke, K., Collins, M., Jones, J.M., Mucklow, J.C.: Perceptions of pain relief after surgery. B.M.J.300:1687, 1990

    Google Scholar 

  3. Brown, D.L., Carpenter, R.L.: Perioperative analgesia: a review of risks an benefits. J. Cardiothorac. Anesth.4:368, 1990

    Google Scholar 

  4. Kehlet, H.: Postoperative pain. In Care of the Surgical Patient, Chapter 12, D. Wilmore, M. Brennan, A. Harken, A. Holcroft, J. Meakins, editors. New York, Scientific American, 1988, p. 1

    Google Scholar 

  5. Woolf, C.J.: Recent advantages in the pathophysiology of acute pain. Br. J. Anaesth.63:139, 1989

    Google Scholar 

  6. Cousins, M.J., Bridenbaugh, P.O., editors: Neural Blockade in Clinical Anesthesia and Management of Pain, 2nd ed. Philadelphia, Lippincott, 1988

    Google Scholar 

  7. Cousins, M.J., Phillips, G.D., editors: Acute Pain Management. New York, Churchill Livingstone, 1986

    Google Scholar 

  8. Woolf, C.J. Central mechanisms of acute pain. In Proceedings VIth World Congress on Pain, M.R. Bond, E. Charlton, C.J. Woolf, editors. Amsterdam, Elsevier, 1991, p. 25

    Google Scholar 

  9. McQuay, H.J., Dickenson, A.H.: Implications of nervous system plasticity for pain management. Anaesthesia45:101, 1990

    Google Scholar 

  10. Cousins, M.J.: Prevention of postoperative pain. In Proceedings VIth World Congress on Pain, M.R. Bond, E. Charlton, C.J. Woolf, editors. Amsterdam, Elsevier, 1991, p. 41

    Google Scholar 

  11. Dahl, J.B., Kehlet, H.: Non-steroidal anti-inflammatory drugs: rationale for use in postoperative pain. Br. J. Anaesth.66:703, 1991

    Google Scholar 

  12. Dahl, J.B., Kehlet, H.: Wound infiltration with local anaesthetics: rationale for use in postoperative pain. (in press)

  13. Covino, B.: Intrapleural regional analgesia. Anesth. Analg.67:427, 1988

    Google Scholar 

  14. Roberts, D., Pizzarelli, G., Lipora, V., Al-Khaja, Belboul, A., Dernevik, L.: Reduction of postthoracotomy pain by cryotherapy of intercostal nerves. Scand. J. Thorac. Cardiovasc. Surg.22:127, 1988

    Google Scholar 

  15. Shafei, H., Chamberlain, N., Natrajan, K.N., Khan, M.R., Gandy, R.G.: Intrapleural bupivacaine for early postthoracotomy analgesia-comparison with bupivacaine intercostal block and cryofreezing. Thorac. Cardiovasc. Surg.38:38, 1990

    Google Scholar 

  16. Bowler, G.M.R., Wildsmith, J.A., Scott, D.B.: Epidural administration of local anaesthetics. In Acute Pain Management, M.J. Cousins, G.D. Philips, editors. New York, Churchill Livingstone, 1986, p. 187

    Google Scholar 

  17. Morgan, M.: The rational use of intrathecal and extradural opioids. Br. J. Anaesth.63:165, 1989

    Google Scholar 

  18. Maze, M., Tranquilli, W.: Alpha-2 adrenoceptor agonists: defining the role in clinical anesthesia. Anesthesiology74:581, 1991

    Google Scholar 

  19. Kehlet, H.: Surgical stress: the role of pain and analgesia. Br. J. Anaesth.63:189, 1989

    Google Scholar 

  20. Tverskoy, M., Cozazov, C., Ayache, M., Bradley, E.L., Kissin, I.: Postoperative pain after inguinal herniorraphy with different types of anesthesia. Anesth. Analg.70:29, 1990

    Google Scholar 

  21. Kehlet, H.: Modification of responses to surgery and anesthesia by neural blockade: clinical implications. In Neural Blockade in Clinical Anesthesia and Management of Pain, M.J. Cousins, P.O. Bridenbaugh, editors. Philadelphia, Lippincott, 1987, p. 145

    Google Scholar 

  22. Kehlet, H.: Neurohumeral response to surgery and pain in man. In Proceedings VIth World Congress on Pain, M.R. Bond, E. Charlton, C.J. Woolf, editors. Amsterdam, Elsevier, 1991, p. 35

    Google Scholar 

  23. Dahl, J.B., Rosenberg, J., Dirkes, W.E., Mogensen, T., Kehlet, H.: Prevention of postoperative pain by balanced analgesia. Br. J. Anaesth.64:518, 1990

    Google Scholar 

  24. Scott, N.B., Kehlet, H.: Regional anaesthesia and surgical morbidity. Br. J. Surg.75:299, 1988

    Google Scholar 

  25. Kehlet, H.: Epidural analgesia and surgical practise. Curr. Pract. Surg.2:223, 1990

    Google Scholar 

  26. Wasylak, T.J., Abbott, F.V., English, M.J.M., Jeans, M.-E.: Reduction of postoperative morbidity following patient controlled morphine. Can. J. Anesth.37:726, 1990

    Google Scholar 

  27. Egbert, A.M., Parks, L.H., Short, L.M., Burnett, M.L.: Randomized trial of postoperative patient controlled analgesia vs intermuscular narcotics in frail elderly men. Arch. Intern. Med.150:1897, 1990

    Google Scholar 

  28. Jackson, D.: A study of pain management: patient controlled analgesia versus intramuscular analgesia. J. Intraven. Nurs.12:42, 1989

    Google Scholar 

  29. Cartwright, P.D., Helfinger, R.G., Howell, J.J., Siepmann, K.K.: Introducing an acute pain service. Anaesthesia46:188, 1991

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Gastroenterology, Hvidovre University Hospital, DK-2650, Hvidovre, Denmark

    Henrik Kehlet M.D., Ph.D. & Jørgen B. Dahl M.D.

Authors
  1. Henrik Kehlet M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jørgen B. Dahl M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kehlet, H., Dahl, J.B. Postoperative pain. World J. Surg. 17, 215–219 (1993). https://doi.org/10.1007/BF01658929

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01658929

Keywords

Search

Navigation