Control of acute pain in postoperative and post-traumatic situations

The past 10 years have seen significant advancement in our understanding of the physiology of acute pain and the introduction of new analgesics, but improvements in the quality of acute pain management have tended to focus on using existing drugs and techniques more effectively. These efforts centre on the introduction of patient-controlled analgesia (PCA) and epidural infusion analgesia, and challenge traditional thinking with improved programmes of education for clinical staff and the introduction of regular assessment and scoring of pain. In the UK, progress has been patchy, with several examples of good practice in the development of dynamic Acute Pain Teams contrasting with many hospitals where little has changed. There is increasing evidence relating good postoperative analgesia to reduced clinical morbidity. In, most cases, acute pain is managed solely with drugs. The role of opioids, tramadol, non-steroidal anti-inflammatory drugs (NSAIDs) and oral analgesics is described and their relative efficacy assessed. Topical agents, nerve blocks, epidural infusions and adjuncts to drug therapy are described. Pain relief in the elderly, children, trauma patients, those with burns, and patients with opioid tolerance or addiction is described.