Summary
After surgery, patients try to minimise discomfort by various manoeuvres including change of posture, immobilisation of injured areas and use of analgesic drugs. The characteristic finding with drug use, revealed by permitting patients to titrate themselves with analgesic from a machine, is that the interindividual dosing rate has a wide range around the mean. Some patients will require almost no drug; others will need 2 to 3 times the mean dosing rate. Wide differences are also seen in the rate at which the need for drug declines. None of these parameters can be predicted with any useful degree of accuracy in the individual patient.
Regimens which rigidly fix dosage in advance, which limit dosage rate through an often ill-founded fear of other pharmacological effects, or which cannot guarantee access of the patient to the drug, are unable to cope with such variation. Dose adjustment through feedback of effect from the patient is essential to combat this uncertainty, and is the prime determinant of optimum therapeutic efficacy. Although risk could be increased as well as benefit, experience shows that almost all patients may be trusted with control of their own pain relief without detrimental sequelae.
Many of the newer therapeutic regimens represent differing attempts at the trade-off between the individualisation (and consequent increased complexity) required for optimum therapeutic efficacy and the rigidity (and consequent increased simplicity) needed for routine implementation. Optimum management results from using a regimen which strikes the right balance for the clinical circumstances of the patient and prescriber.
Similar content being viewed by others
References
Bullingham, R.E.S.: Postoperative pain. Postgraduate Medical Journal 60: 847–851 (1984).
Catling, J.A.; Pinto, D.M.; Jordan, C. and Jones, J.G.: Respiratory effects of analgesia after cholecystectomy: Comparison of continuous and intermittent papaveretum. British Medical Journal 281: 478–480 (1980).
Harmer, M.; Slattery, P.J.; Rosen, M. and Vickers, M.D.: Intramuscular on demand analgesia: Double blind controlled trial of pethidine, buprenorphine, morphine, and meptazinol. British Medical Journal 286: 680–682 (1983).
Jacobs, O.L.R. and Bullingham, R.E.S.: Modelling, estimation and control for demand analgesia. European Journal of Anaeslhesiology (In press 1984).
Keenan, D.J.M.; Cave, K.; Langdon, L. and Lea, R.E.: Comparative trial of rectal indomethacin and cryoanalgesia for control of early poslthoracotomy pain. British Medical Journal 287: 1335–1337 (1983).
Keeri-Szanto, M.: Drugs or drums: What relieves postoperative pain? Pain 6: 217–230 (1979).
Mather, L.E.: Pharmacokinetic and pharmacodynamic factors influencing the choice, dose and route of administration of opiates for acute pain; in Bullingham (Ed.) Opiate Analgesia, Clinics in Anaesthesiology, Vol. 1, No. 1, pp. 17–40 (Saunders, London 1983).
Orr, I.A.; Keenan, D.J.M. and Dundee, J.W.: Improved pain relief after thoracotomy: Use of cryoprobe and morphine infusion. British Medical Journal 283: 945–948 (1981).
Porter, J. and Jick, H.: Addiction rare in patients treated with narcotics. New England Journal of Medicine 302: 123 (1980).
Tamsen, A.; Hartvig, P.; Fagerlund, C. and Dahlstrom, B.: Patientcontrolled analgesic therapy. II. Individual analgesic demand and analgesic plasma concentrations of pethidine in postoperative pain. Clinical Pharmacokinetics 7: 164–175 (1982).
Wood, L.J.; Lloyd, J.W.; Bullingham, R.E.S.; Britton, B.J. and Finch D.R.A.: Postoperative analgesia for day-case herniorraphy patients: A comparison of cryoanalgesia, paravertebral blockade and oral analgesia. Anaesthesia 36: 603–610 (1981).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bullingham, R.E.S. Optimum Management of Postoperative Pain. Drugs 29, 376–386 (1985). https://doi.org/10.2165/00003495-198529040-00004
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-198529040-00004