BJA Advance Access originally published online on December 3, 2004
British Journal of Anaesthesia 2005 95(1):43-51; doi:10.1093/bja/aei037
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2004. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org
REVIEW ARTICLE |
Recent advances in postoperative pain therapy
Anaesthesia, Critical Care and Pain Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Little France, Edinburgh EH16 4SA, UK
E-mail: ian.power@ed.ac.uk
Keywords: analgesic techniques, i.v.; analgesics non-opioid, acetaminophen; analgesics non-opioid, nitroxyparacetamol; analgesics opioid, peripheral; enzymes, cyclooxygenase 2, inhibitors; pain, acute, postoperative; pain, neuropathic; therapy, non-pharmacological
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Introduction |
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Despite many advances in the provision of pain services, acute pain after surgery remains a serious cause of severe suffering that is often undermanaged despite our best efforts.6 34 37 Acute pain teams have been introduced in many hospitals, but recent evidence from a UK national postal questionnaire suggests that they are struggling with the problem of alleviating acute pain successfully.90 In a review of published data of pooled pain scores from nearly 20 000 surgical patients having intramuscular, patient controlled analgesia (PCA) or extradural analgesia, the overall mean (95% confidence interval) incidence of moderate to severe and severe pain was 29.7 (26.4–33.0)% and 10.9 (8.4–13.4)%, respectively.37 Often the provision of effective postoperative analgesia is limited by side-effects, and these have been quantified in contemporary anaesthetic practice by Cashman and Dolin with special attention to respiratory depression and hypotension after intramuscular, PCA and extradural analgesia,28 in a companion paper to their study
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Non-pharmacological methods of postoperative pain relief |
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Peripheral opioid analgesia |
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Cyclooxygenase-2-selective inhibitors (COX-2 inhibitors) |
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Prostaglandin inhibition
The analgesic efficacy of COX-2 inhibitors
Adverse effects
Gastrointestinal
Platelet function and thrombotic sequelae
Renal function
Aspirin-induced asthma
Bone healing
Intravenous paracetamol and nitroxyparacetamol
Intravenous paracetamol
Nitroxyparacetamol
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Acute neuropathic pain in the postoperative period |
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Conclusion |
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  A. E. Powell, H. T. O. Davies, J. Bannister, and W. A. Macrae Challenge of improving postoperative pain management: case studies of three acute pain services in the UK National Health Service Br. J. Anaesth., June 1, 2009; 102(6): 824 - 831. [Abstract] [Full Text] [PDF]
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J. M. Hunter The Recovery Period Br. J. Anaesth., July 1, 2005; 95(1): 1 - 2. [Full Text] [PDF]
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E-letters:
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- Letter to the Editor, Re; Recent advances in postoperative pain therapy
- Sudarshana H Gururajarao, et al.
- British Journal of Anaesthesia, 24 Aug 2005 [Full text]