Best practice & research. Clinical anaesthesiology
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To implement a successful acute pain service the following factors are the most important for success: anaesthesiologist-supervised pain nurses and an ongoing educational programme for patients and all health personnel involved in the care of surgical patients. The benefits in increased patient satisfaction and improved outcome after surgery will far outweigh the costs of running an acute pain service that raises standards of pain management throughout the hospital. Optimal use of basic pharmacological analgesia will improve relief of post-operative pain for most surgical patients. ⋯ Chronic pain is common after surgery. Better acute pain relief may reduce this distressing long-term complication of surgery. Research into the long-term effects of optimal neuraxial analgesia and drugs that dampen glutamatergic hyperphenomena (hyperalgesia/allodynia) are urgently needed to verify whether these approaches can reduce the problem of intractable chronic post-operative pain.
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Best Pract Res Clin Anaesthesiol · Dec 2002
ReviewDrug combinations in pain treatment: a review of the published evidence and a method for finding the optimal combination.
The evidence of the usefulness of drug combinations in pain management is reviewed and the problem of finding the optimal combination is presented. For post-operative pain, adding a non-steroidal anti-inflammatory drug (NSAID) or paracetamol to intravenous morphine is beneficial. Adding ketamine to intravenous morphine may be advantageous, but ketamine has a narrow therapeutic window. ⋯ Adding NSAIDs or ketamine to opioids may be useful in cancer pain. Because of the enormous number of possible combinations, randomized controlled trials may fail to test the optimal combination. A stepwise optimization model that has been applied in clinical investigations is presented.