Postoperative analgesia – a multimodality approach

Myles and Power discuss their approach to post operative analgesia. Acetaminophen (oral or intravenous) at fixed dosing intervals forms the base of their post operative analgesic regimen to which is added a narcotic such as morphine for major surgery or oral oxycodone for “minor” procedures.  They emphasize that “simple standardized analgesic regimens can lead to better pain control and reduced post operative complications.”  They also note that in addition to pain scores to titrate narcotic needs, sedation scores may provide an early warning of opioid overdose.  They note the benefits of PCA compared to intermittent nurse provided doses and the use of local anesthetic blocks of various kinds to reduce narcotic use.  They feel strongly that multimodality approaches provide the best route to good pain relief while minimizing the risk of complications (Clinical update: post operative analgesia.  The Lancet 2007;369:810-812)

David S. Smith, M.D., Ph.D.