[A modern concept of postoperative pain therapy]

Pain relief should be considered part of a multimodal postoperative approach. Combining patient-controlled pain therapy with other measures i.e. respiratory therapy or early mobilisation improves the outcome after surgery. In many patients adequate postoperative pain relief can be achieved by an optimal use of traditional pain management strategies. Therefore different levels of therapy should be introduced. On the first level nursing staff on surgical wards should treat pain. Patients undergoing extended surgery will need the advanced techniques of a postoperative pain service including balanced analgesia with antipyretic analgetics, patient-controlled intravenous opioids and epidural drug administration. Low dose combinations of local anaesthetics and opioids administered via thoracic epidural catheters result in excellent analgesia and provide the most effective means in improving outcome after surgery. For optimal adjustment of the patient-controlled techniques and early detection of side effects and complications nursing staff must be integrated into the pain service. Such a structured pain management program requires the training of nurses in the principles and techniques of postoperative pain treatment. Dosage of patient-controlled intravenous opioids or epidural drug combinations must be adjusted to the individual needs of the patients. Best results can only be achieved if the patient remains under observation by the pain service. This requires daily or twice daily rounds including an adequate documentation of pain relief, side effects and complications.