Treating postoperative pain improves outcome.
Recent surveys show that many patients still receive inadequate post-surgical analgesia, this problem is international in character. Analgesia techniques like patient-controlled analgesia (PCA) and spinal opioids alone or in combination with local anaesthetics provide superior pain relief compared to intermittent i.m. injections of opioids. Patient satisfaction with these techniques is high; however, reduced pain and suffering or high patient satisfaction is not considered sufficient in this age of diminished health care budgets. There is no overwhelming evidence that effective postoperative pain relief assures good postoperative outcome. Most studies lack sufficient statistical power to detect clinically significant differences. A meta-analysis showed higher patient satisfaction with i.v. PCA compared to i.m. opioid injection. Although PCA still is the standard of care there's little rational or scientific evidence that i.v. PCA improves outcome. A meta-analysis of randomized, controlled trials to assess the effects of seven analgesic therapies on postoperative pulmonary function after various procedures has shown that postoperative epidural pain control can significantly decrease the incidence of pulmonary morbidity. None of the other analgesic techniques had a significant impact on pulmonary outcome. There are few outcome studies with peripheral nerve blocks. Evidence that peripheral nerve blocks are better than PCA and safer than epidural increases. One reason why improved outcome is difficult to demonstrate is that pain management strategies are not integrated with overall perioperative care and postoperative rehabilitation of the patient. The importance of a good APS in developing cost-effective, evidence-based pain treatment strategies for different surgical procedures should not be underestimated.