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Query: UMLS:C0030201 (Postoperative pain)
 1,085 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The surgical requirement for thoracoscopy is a good view of the contents of the thorax. This is achieved by capitalizing on natural consequences and the skills of anaesthesiologists to produce a pneumothorax and collapse the ipsilateral lung--a process that is commonly enhanced by insufflating carbon dioxide. Insufflating CO2 to actively promote lung collapse creates the dynamics of a tension pneumothorax. Complications are clinically insignificant if CO2 is used judiciously. There is a body of experience using ordinary endotracheal tubes and two-lung ventilation. Techniques of one-lung ventilation are more widely reported. All the factors known to contribute to the significant increase in shunt fraction associated with one-lung ventilation apply. The manoeuvre of collapsing a lung is no longer regarded as benign. Chemical attempts to produce a reversible post-pneumonectomy pulmonary circulation have not been shown to be an improvement. Post-operative pain can be severe. The mechanism is not defined but it differs from that associated with thoracotomy. Epidural analgesia and opioids may be required. Chronic pain syndromes have been described as complications.
Best Pract Res Clin Anaesthesiol 2002 Mar
PMID:Anaesthesia for thoracoscopic surgery. 1249 43

Local anaesthetics (LA) are increasingly being used intraoperatively for the prevention of postoperative pain. The efficacy of local anaesthetic infiltration into incision sites has only been shown in patients undergoing inguinal herniorrhaphy. However, in one meta-analysis of the literature, intraperitoneal LA have been shown to be effective for pain relief following laparoscopic cholecystectomy (LC). The present review of the literature was done to summarise current knowledge on the effects of LA following LC. The Medline database was searched via PubMed to identify relevant randomised clinical trials in patients undergoing LC and where LA was used for pain management. The literature was restricted to adults (> 19 years) and humans. Abstracts of all articles were searched to determine if the trial was a comparison between LA and placebo injected intraperitoneally or infiltrated locally, with relevant postoperative data on pain scores, analgesic consumption and side effects. A total of 31 relevant studies were identified from which data could be extracted. Postoperative pain, in general, was mild to moderate after LC, worst at the incision site or intra-abdominally. Five of six studies in which LA were injected locally found beneficial effects on postoperative pain but not analgesic consumption for up to 24 hours postoperatively. When injected intraperitoneally, 14 of 23 studies found a reduction in pain scores in the LA group but only 9 of 21 found a reduction in analgesic consumption. A meta-analysis of only three studies with extractable data found no difference in abdominal pain during 0-24 hours between the LA and placebo groups. Side effects were few but some studies reported toxic plasma concentrations of LA in some patients, although no symptoms of LA toxicity were seen in these patients. In conclusion, LA have some beneficial effects when infiltrated locally and intraperitoneally. Although side effects are rare, the dose of LA should be monitored closely to avoid toxicity. Future studies should be directed towards determining whether the analgesic effects of LA are via peripheral mechanisms or systemic absorption. The explanation for the wide interindividual variation in pain following LC should also be better investigated.
Best Pract Res Clin Anaesthesiol 2005 Jun
PMID:Local anaesthesia for pain relief after laparoscopic cholecystectomy--a systematic review. 1596 98

Postoperative pain management aims not only to decrease pain intensity but also to increase patient comfort and to improve postoperative outcome. Better pain control is achieved through a multimodal combination of regional analgesic techniques and systemic administration of analgesic agents. To guarantee uneventful follow-up and unnecessary prolongation of hospital stay, it is important to avoid side-effects of analgesic agents, especially those of opioids which are dose-related, by decreasing opioid demand through combination with non-opioid agents. Epidural analgesia not only has the advantage of providing potent and effective analgesia but also of hastening recovery of bowel function and facilitating physiotherapy and rehabilitation. Unfortunately, a reduction in postoperative morbidity and mortality by epidural analgesia has not actually been demonstrated. Inclusion of postoperative pain treatment in a multimodal approach of patient rehabilitation may improve recovery and shorten hospital stay. Effective treatment of postoperative pain is also likely to prevent chronic pain syndrome after surgery, but further studies are needed to support this hypothesis.
Best Pract Res Clin Anaesthesiol 2007 Mar
PMID:Postoperative pain management and outcome after surgery. 1748 22

Anaesthesiologists will be asked to provide pain management for cancer patients in the absence of more specialised services, when interventional techniques are indicated and in the postoperative period. In all these settings, the complexity of cancer pain and its psychosocial connotations need to be considered to provide appropriate and holistic care. Principles of systemic pain management, effective in most patients, continue to follow established guidelines; identification of neuropathic pain and its appropriate treatment is important here. Interventional pain relief is required in a minority of cancer patients, but it should be considered when appropriate and then done with best available expertise. Neurolytic procedures have lost importance here over the years. Postoperative pain management should be multimodal with consideration of regional techniques when applicable. In managing postoperative pain in cancer patients, opioid tolerance needs to be addressed to avoid withdrawal and poor analgesia. Preventive techniques aiming to reduce chronic postoperative pain should be considered.
Best Pract Res Clin Anaesthesiol 2013 Dec
PMID:Pain management for the cancer patient - current practice and future developments. 2426 57

Post-operative pain management protocols may be optimised by examining procedure-specific evidence and outcomes. This recognition led to the formation of the PROcedure-SPECific Pain ManagemenT (PROSPECT) collaboration of anaesthesiologists and surgeons. The aim of PROSPECT is to provide practical and evidence-based recommendations to prevent and treat post-operative pain after specific surgical procedures, thereby overcoming the limitations of generic, non-specific guidelines. Updates in the methodology of PROSPECT in 2017 have placed an increased emphasis on the clinical relevance of studies, including a focus on interventions in the context of multimodal analgesia strategies and consideration of risks and benefits of interventions in specific surgical settings. Evidence-based reviews of analgesic measures, including advice on surgical techniques and adjuvants after diverse surgical procedures, have been completed by the PROSPECT collaboration and are accessible on the website (www.postoppain.org) and published in the peer-reviewed literature. These reviews continue to identify significant gaps in clinically relevant research on post-operative analgesia and are possibly leading to a closing of some of these gaps.
Best Pract Res Clin Anaesthesiol 2018 Jun
PMID:Procedure-Specific Pain Management (PROSPECT) - An update. 3032 52

Enhanced recovery after surgery (ERAS) programmes are increasingly becoming standard of care for several surgical procedures. However, compliance with ERAS protocols including pain management protocols remains poor. The PROSPECT (PROcedure-SPEcific Postoperative Pain ManagemenT) collaboration provides evidence-based, procedure-specific pain management recommendations presented as preoperative, intraoperative and postoperative interventions as well as surgical interventions that are easy to access, transparent and relevant to clinicians. This approach should facilitate incorporation of pain management recommendations in an ERAS protocol and improve compliance with the protocols. This article presents an improved approach to developing pain management guidelines as well as a pragmatic approach to procedure-specific perioperative pain management that could be incorporated in an ERAS pathway.
Best Pract Res Clin Anaesthesiol 2019 Sep
PMID:Postoperative pain management in the era of ERAS: An overview. 3178 12

Postoperative pain and opioid use are major challenges in perioperative medicine. Pain perception and its response to opioid use are multi-faceted and include pharmacological, psychological, and genetic components. Precision medicine is a unique approach to individualized health care in which decisions in management are based on genetics, lifestyle, and environment of each person. Genetic variations can have an impact on the perception of pain and response to treatment. This can have an effect on pain management in both acute and chronic settings. Although there is currently not enough evidence for making recommendations about genetic testing to guide pain management in the acute care setting, there are some known polymorphisms that play a role in surgical pain and opioid-related postoperative adverse outcomes. In this review, we describe the potential use of pharmacogenomics (PGx) for improving perioperative pain management. We first review a number of genotypes that have shown correlations with pain and opioid use and then describe the importance of PGx-guided analgesic protocols and implementation of screening in a preoperative evaluation clinical setting.
Best Pract Res Clin Anaesthesiol 2020 Jun
PMID:Genomics testing and personalized medicine in the preoperative setting: Can it change outcomes in postoperative pain management? 3271 34