ANALGESIA TECHNIQUE AND POSTOPERATIVE MORBIDITY

Good analgesia does not normalize post-operative pulmonary function bu t is important in allowing measures such as post-operative physiothera py to be applied following major abdominal or thoracic surgery. Clinic al studies have generally failed to duplicate animal work on the effec tiveness of pre-emptive analgesia possibly because the nociceptor stim uli persist as long as there is wound pain. Anaesthetic techniques whi ch include sensory blockade are associated with a lower incidence of s everal post-operative complications and this improvement is more marke d in high-risk patients. The contributions of spinal opioids to this i s not known. Long-lasting analgesia can be provided via a catheter ins erted in a relevant neurovascular compartment. There is no evidence th at multimodal 'balanced' analgesia offers any advantages in terms of i mproved outcome or reduction in adverse events. Whilst sophisticated m ethods for providing post-operative pain relief, such as PCA and PCEA, are highly effective, they are appropriate for only a minority of sur gical operations. An Acute Pain Service can delivery a traditional int ermittent opioid regime effectively at relatively low cost.