[How can pain of surgery be limited?]

Postoperative pain is due to direct stimulation of nociceptors by surgical trauma, and by algogenic substances produced by damaged tissues. Control of surgical pain can be obtained by limiting the extent of damage to tissues as well as the choice of incision. Endoscopic or video-assisted surgery is an effective mean to reduce pain caused by surgical approach. It is widely used in abdominal, thoracic, orthopaedic surgery, and urology. Many studies have shown a reduction of postoperative pain by laparoscopy for gynaecological surgery and cholecystectomy, but for other procedures the potential advantage of laparoscopic surgery has not yet been established. Conventional open surgery is still widely used. It has been suggested that transverse laparotomies are less painful than midline incisions, and that incision by electrocautery was less painful than with scalpel; but this has not been strictly established. Infiltration of wounds or nerves with local anaesthetic agents is a way of clinical research, which merits further investigation. Whether delicacy in surgery is capable of minimising pain by limiting tissue attrition remains to be demonstrated. Finally, drains and catheters, particularly the naso-gastric tube, which are responsible for pain, could be abandoned when not essential.