1、Postoperative Pain Management*The following only stand by personal opinion.Naropin prescription should follow product instruction.Postoperative Pain Continues To Be UndertreatedDespite nearly a decade of progress in pain research,39%of patients reported severe-to-extreme postoperative pain in 2003 v
2、ersus 31%in 19951Warfield CA,Kahn CH.Anesthesiology.1995;83(5):1090-1094.2Apfelbaum JL,et al.Anesth Analg.2003;97(2):534-540.SevereExtremeModerateMild1995120032SevereExtremeModerateMild19%49%23%8%47%21%18%13%PsychologicalPsychological Patient attiudes Preop anxiety Expectation of chronicityEnvironme
3、ntalEnvironmental Poor education Low income Poor self-rated healthSurgicalSurgical Severity of postopertaive pain Surgical factors-site and extent of surgery-damage to nerves-reoperations-bleeding,infectionPreoperativePreoperative Female gender Younger age Pain before surgery Analgesic useGenetic pr
4、edispositionGenetic predisposition RCT,n=188(1971-2006),n=5904 Epidural analgesia associated with:-decreased risk of pneumonia(OR 0.54)-incidence unchanged(8%)from 1971-2006 with EA but decreased(34%to 12%)with systemic analgesia -improved pulmonary function -reduced risk of myocardial infarct(NNT 4
5、8)-increased risk of hypotension(OR 2.0),urinary retention(OR 2.2)and pruritus(OR 6.5 morphine,OR 3.1 fentanyl,OR 1.1 sufentanil)ANESTHESIA RA techniques Procedure specific ()APS organizationPHYSIOTHERAPY Pre-set mobilization routinesPATIENT ASA status Information,”contract”pre-set goals Life style(
6、smoking,alcohol)SURGERY High volume surgeon/hospital Skillful surgeon Surgery specific registersSURGICAL WARD Pain mgmt policy(VAS 3)Clinical pathways,pre-set goals Regular auditsMultifactorial nature of postoperative outcome?Prevention of cancer recurrence?ANESTHESIA RA techniques Procedure specifi
7、c ()APS organizationPHYSIOTHERAPY Pre-set mobilization routinesPATIENT ASA status Information,”contract”pre-set goals Life style(smoking,alcohol)SURGERY High volume surgeon/hospital Skillful surgeon Surgery specific registersSURGICAL WARD Pain mgmt policy(VAS 3)Clinical pathways,pre-set goals Regular auditsMultifactorial nature of postoperative outcome
