Pain management after ambulatory surgery - where is the disconnect?

摘要

DESPITE recent advances in our knowledge of multimodal analgesic therapies for pain management, many patients undergoing ambulatory surgery continue to experience unacceptable levels of pain after their operations. Postoperative pain is a complex and multi-factorial symptom which requires a thoughtful approach using a variety of treatment modalities to obtain optimal outcomes with respect to patient comfort and facilitating the recovery process. Multimodal (or "balanced") analgesia represents an approach to preventing postoperative pain that involves administering a combination of opioid and non-opioid analgesics, that act at different sites within the central and peripheral nervous systems, in an effort to eliminate opioid-related side effects. The current armamentarium of analgesic drugs and techniques for the management of postoperative pain continues to grow at a rapid rate. However, there appears to be a significant 'disconnect' between the publication of analgesic studies in the peer-reviewed literature demonstrating approaches to improving acute pain management and the application of these concepts in clinical practice.