Does Postoperative Analgesia Affect Outcome?

摘要

A significant number of patients continue to experience unacceptable levels of pain after surgery. Undertreated severe pain has several deleterious effects on neuroendocrine function, respiration, gastrointestinal function, circulation, and autonomic activity. This is particularly relevant for patients undergoing thoracic and major abdominal surgery. In this era of dimished health care budgets reduced pain and suffering or good patient satisfaction alone is not considered sufficient. Therefore, the increased costs of newer analgesic techniques have to be justified in terms of better outcomes such as reduced morbidity and shorter hospitalization. There is no overwhelming evidence that effective postoperative pain relief assures good postoperative outcome. Many studies have demonstrated that local anesthetic-containing epidural techniques reduce adverse physiologic responses to surgery; however, the true impact of this technique remains controversial. Most studies lack sufficient statistical power to detect clinically significant differences; many studies do not meet the necessary criteria for a controlled trial.