New trends in the treatment of post-operative pain in general and gastrointestinal surgery

Santeularia Vergés, María Teresa; Puigbò, Elena Català; Cortada, Mercè Genové; Rizo, Miren Revuelta; Moral García, María Victoria

doi:10.1016/S2173-5077(09)70072-9

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Abstract

The correct application of multimodal analgesia appropriate to the pain intensity, the characteristics of the surgery, and the hospitalisation scheme provide the key to improving the management of postoperative pain, which is currently still under treated. In highly complex surgeries the best benefit is obtained by combining systemic analgesic drugs with regional analgesia techniques. Epidural analgesia, not only provides an excellent quality of analgesia, but can prevent complications and reduce postoperative morbidity. Recently, peripheral blocks and parietal infiltration techniques, with or without catheter, have gained prominence in the postoperative analgesia of haemorrhoids and hernia repair. All these analgesic techniques are integrated into the concept of early postoperative rehabilitation and pursue the objective of minimising the side effects associated with the treatment and facilitate the functional recovery of the patient. In addition, proper postoperative pain management not only increases the quality of in-patient care but is also a factor to consider in the development of chronic post-surgical pain, where the impact is significant and impairs the quality of life of the patients.

Keywords:

Postoperative pain

Multimodal analgesia

Regional analgesia

Systemic analgesia

Opioids

Resumen

Una correcta aplicación de la analgesia multimodal que resulte adecuada a la intensidad del dolor, a las características de la cirugía y al régimen de hospitalización planteado aportará la clave para mejorar el manejo del dolor postoperatorio, actualmente infratratado. En las cirugías de alta complejidad el mejor beneficio se obtiene al asociar los analgésicos a las técnicas de anestesia locorregional. La analgesia epidural no sólo proporciona una excelente calidad analgésica, sino que puede prevenir complicaciones y reducir la morbimortalidad postoperatoria. Últimamente, los bloqueos periféricos y las técnicas de infiltración, parietal con o sin catéter, han adquirido mayor protagonismo en la analgesia postoperatoria de cirugías como hemorroides o herniorrafias. Todas estas técnicas analgésicas se integran en el concepto de rehabilitación postoperatoria precoz y persiguen como objetivo minimizar los efectos secundarios asociados al tratamiento y facilitar la recuperación funcional del paciente. Además, el correcto manejo del dolor postoperatorio no sólo aumenta la calidad asistencial intrahospitalaria, sino que es un factor que se debe considerar en el desarrollo del dolor crónico posquirúgico, cuya incidencia es significativa y deteriora la calidad de vida de los paciente.

Palabras clave:

Dolor postoperatorio

Analgesia multimodal

Analgesia regional

Analgesia sistémica

Opioides

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