Pain relief after surgery

Relief of pain after surgery remains poor for the majority of patients. The pain is unpleasant, and is associated with arterial hypoxaemia, venous thrombosis, myocardial ischaemia and a more florid hormonal response to surgery. Regional analgesia, systemic, subarachnoid or extradural opioids and antiprostaglandin drugs are all used to treat pain after surgery. Systemic opioids are used usually, because regional and axial techniques are labour intensive and antiprostaglandin drugs ineffective. Opioids given orally undergo extensive first pass metabolism and intramuscular doses are absorbed unpredictably. Intravenous administration avoids both problems and excellent results have been obtained using Patient Controlled Analgesia devices, but these machines are expensive. A simple regimen suitable for application to large numbers of surgical patients is required. Continuous infusion of fentanyl 100 micrograms h-1 IV begun two hours before surgery and supplemented by a single bolus dose of fentanyl 100 micrograms IV provided an effective background of analgesia.