Abstract
Postoperative analgesia has changed dramatically during approximately last three decades. At the beginning, postoperative pain in patients at surgical wards was an insignificant matter, pain was supposed to be an integral part of surgical treatment.
Thanks to the effort of the first enthusiasts, postoperative pain started to be studied and treated. This resulted in development of acute pain services, later perioperative pain services and concept of ERAS - Enhanced Recovery after Surgery.
By-products of this research were new drugs, new forms of old drugs, new methods of their administration, new types of organisation of care for a surgical patient and even discovery of new complications, like chronic or persistent postoperative pain. The review presents individual components used to improve the quality of life of patients after surgery and in some cases decreasing the risk of complications.
Many studies demonstrated that in spite of the progress in knowledge and technology, the treatment of postoperative pain remains still suboptimal and approximately one third of patients after surgery suffer from strong or severe pain. Essential part of successful therapy is measurement of intensity of pain and the effect of analgesic therapy.
Multimodal analgesia is used to decrease side effects of individual drugs, mainly opioids. The results of meta-analyses confirm that the most frequently used and the safest non-opioid drug is paracetamol.
Less commonly used but also with a good profile is metamizol (dipyrone). Non-steroidal anti-inflammatory drugs are not recommended because of their potentially serious side effects.
Important role in treatment of acute and chronic pain has ketamine. Other adjuvant drugs have not proved their efficacy except of systemic lidocaine; gabapentinoids should not be used in this indication at all.
Opioid therapy remains the foundation of postoperative pain treatment. There are some new opioids under development; new methods of patient controlled analgesia are used.
Very important components of multimodal analgesia are loco-regional methods. Recent trend is changing strategy of administration of local anaesthetics from centre to periphery: from epidural catheters to more peripheral blocks and finally to local wound infiltration.
Organisation of care for the patient is important for the success: acute pain services, perioperative care services, ERAS. Well recognised but unsolved is the phenomenon of persistent or chronic postoperative pain, which is frequently preceded by abnormal intensive acute postoperative pain.
At present, there is a lack of possibility of detection of risk persons as well as prevention. At the end, possible future trends and possible obstructions of successful postoperative pain therapy are discussed