Current concepts and practice in postoperative pain management: Need for achange?

Despite a growing trend in acute pain management, many deficiencies still a ccount for the high incidence of moderate to severe postoperative pain to d ate. Patients nowadays continue to receive inadequate doses of analgesics, but additionally the identification a nd treatment of those patients with p ain still remains a significant health care problem. Advanced techniques ar e available including epidural or intrathecal administration of local anaes thetics and opioids, various opioid administration techniques such as patie nt-controlled analgesia and infusions via sublingual, oral-transmucosal, na sal, intra-articular and rectal routes. Nonopioid analgesics such as nonste roidal anti-inflammatory drugs and newer nonopioid drugs such as alpha(2)-a drenergic agonists, calcium channel antagonists and various combinations of the above are possible. However, the solution to the problem of inadequate pain relief lies not so much in the development of new drugs and new techn iques, but in the effective strategy of delivering these to patients throug h the introduction of acute pain management Services on surgical wards.