Analgesia technique and post-operative morbidity

Good analgesia does not normalize post-operative pulmonary function but is important in allowing measures such as post-operative physiotherapy to be applied following major abdominal or thoracic surgery. Clinical studies have generally failed to duplicate animal work on the effectiveness of pre-emptive analgesia possibly because the nociceptor stimuli persist as long as there is wound pain. Anaesthetic techniques which include sensory blockade are associated with a lower incidence of several post-operative complications and this improvement is more marked in high-risk patients. The contributions of spinal opioids to this is not known. Long-lasting analgesia can be provided via a catheter inserted in a relevant neurovascular compartment. There is no evidence that multimodal 'balanced' analgesia offers any advantages in terms of improved outcome or reduction in adverse events. Whilst sophisticated methods for providing post-operative pain relief, such as PCA and PCEA, are highly effective, they are appropriate for only a minority of surgical operations. An Acute Pain Service can delivery a traditional intermittent opioid regime effectively at relatively low cost.