Pain Management

Postoperative pain management is essential and must be approached as an integral part of the perioperative care. It should be systematic and based on sound physiological and pharmacological principles. The intra operative management of pain is crucial, because there is perhaps an important role for preemptive analgesia. Because of its unique nature, pain is difficult to assess; for good results, adequate and repeated assessment are vital. The literature also points to the detrimental ef fects of inadequate pain control. There are a variety of methods available for pain management. In choosing a method, various factors need to be considered includ ing: (1) physician skill, (2) knowledge of analgesics and routes of administration, (3) patient and clinically re lated circumstances, (4) the availability of an environ ment supportive of effective pain management, and (5) the knowledge and skill of staff to assess and monitor patients. These need to be considered along with the risk-benefits and cost-benefit of the various drugs and techniques. The cornerstone of therapy is opioids, which can be administered by a variety of routes. The use of thoracic epidural analgesia (TEA) with opioids and local anesthetics is highly beneficial, especially in high-risk patients. The aim should be to provide all patients a balanced analgesic regimen based on the identification of multiple mechanisms involved in postoperative pain.