Acute postoperative pain: logical treatment by drug combinations

Most patients who undergo major surgery suffer severe postoperative pain. This fact has been known by many generations of health care workers, and highlighted in the report of the Working Party organised jointly by the Colleges of Surgeons and Anaesthetists of Great Britain. Although effective therapies exist they are frequently not used in an effective manner. Everyone knows that enough morphine will abolish pain. However, the doses of a drug such as morphine required to completely relieve a patient's pain may cause several side effects or even death. There is an enormous variability between patients and operations in morphine requirements to relieve postoperative pain. Many patients are not given adequate doses for fear of inducing side effects. It is obvious that provision of postoperative pain relief tailored to each individual patient's needs requires more than a 'prn Omnopon' prescription. The level of pain needs to be monitored in much the same way as we would monitor blood pressure or urine output postoperatively and health workers who understand these readings and the appropriate treatment should review them.