POSTOPERATIVE OPIOID ANALGESIA - TIME FOR A RECONSIDERATION

Postoperative pain relief has improved in recent years with the develo pment of new analgesics, additional routes of administration and the a ppearance of the hypothesis of preemptive as well as balanced analgesi a (Kehlet H: Postoperative pain relief-what is the issue? Br J Anaesth 1994;72:375-8), Many initial improvements simply involved the adminis tration of opioid analgesics in new ways such as continuous or on dema nd intravenous (IV) or epidural infusion. These methods allow lower to tal opioid dosages, provide a more stable concentration of opioid at t he receptor and correspondingly better analgesic effects, and also few er unwanted side effects. Although opioids have played a prominent rol e in postoperative analgesia for centuries and are still often adminis tered as a matter of routine, their frequent minor side effects and th e increasing availability of suitable alternatives may limit their fut ure use in some situations. Thus, the recent emphasis on ambulatory su rgery and accelerated surgical stay programs, both with a focus on ear ly recovery of organ function and provision of functional analgesia [i e, pain relief that allows normal function (Kehlet H: Postoperative pa in. relief-what is the issue? Br J Anaesth 1994;72:375-8)] provide an opportunity for a reappraisal of opioid use in these settings. Ebr thi s debate, controlled clinical studies on the Opioid-sparing effect of different analgesic techniques are mentioned, and preferably studies w ith multiple dosing of analgesics and/or a reasonably large patient sa mple size. These data do not allow a proper meta-analysis to be perfor med because of the large variability in surgical procedures, dosing re gimens, assessment criteria among others.