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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References

[1.]

D.O. Warner.

Preventing postoperative pulmonary complications: The role of the anesthesiologist.

Anesthesiology, 92 (2000), pp. 1467-1472

Medline

[2.]

M. Nishimori, J.C. Ballantyne, J.H. Low.

Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery.

Cochrane Database Syst Rev, 3 (2006),

http://dx.doi.org/10.1002/14651858.CD009601.pub2 | Medline

[3.]

S.S. Liu, B.M. Block, C.L. Wu.

Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery: A meta-analysis.

Anesthesiology, 101 (2004), pp. 153-161

Medline

[4.]

J.C. Ballantyne, D.B. Carr, S. DeFerranti, T. Suarez, J. Lau, T.C. Chalmers, et al.

The comparative effects of postoperative analgesic therapies on pulmonary outcome: Cumulative meta-analyses of randomized, controlled trials.

Anesthesia Analgesia, 86 (1998), pp. 598-612

Medline

[5.]

M. Genové, T. Santeularia, M. Revuelta.

Dolor postoperatorio.

Manual del tratamiento del dolor, 2 ed., pp. 208-239

[6.]

B. Mugabure Bujedo, I. Tranque Bizueta, S. Gonzalez Santos, R. Adrián Gard.

Estrategias para el abordaje multimodal del dolor y de la recuperación postoperatoria.

Rev Esp Anestesiol Reanim, 54 (2007), pp. 29-40

Medline

[7.]

H. Kehlet, D.W. Willmore.

Multimodal strategies to improve surgical outcome.

Am J Surg, 183 (2002), pp. 630-644

Medline

[8.]

F. Bonnet, E. Marret.

Influence of anaesthetic and analgesic techniques on outcome after surgery.

Br J Anaesth, 95 (2005), pp. 52-58

http://dx.doi.org/10.1093/bja/aei038 | Medline

[9.]

J.P. Rathmell, C.L. Wu, R.S. Sinatra, J.C. Ballantyne, B. Ginsberg, D.B. Gordon, et al.

Acute post-surgical pain management: A critical appraisal of current practice.

Reg Anesth Pain Med, 31 (2006), pp. 1-42

http://dx.doi.org/10.1016/j.rapm.2006.05.002 | Medline

[10.]

J. Bonnefont, L. Daulhac, M. Etienne, E. Chapuy, C. Mallet, L. Ouchchane, et al.

Acetaminophen recruits spinal p42/p44 MAPKs and GH/IGF-1 receptors to produce analgesia via the serotonergic system.

Mol Pharmacol, 71 (2007), pp. 407-415

http://dx.doi.org/10.1124/mol.106.025775 | Medline

[11.]

G.G. Graham, K.F. Scott.

Mechanism of action of paracetamol.

Am J Ther, 12 (2005), pp. 46-55

Medline

[12.]

B.M. Block, S.S. Liu, A.J. Rowlingson, A.R. Cowan, J.A. Cowan, C.L. Wu.

Efficacy of postoperative epidural analgesia: A meta-analysis.

JAMA, 290 (2003), pp. 2445-2463

[13.]

C.L. Wu, S.R. Cohen, J.M. Richman, A.J. Rowlingson, G.E. Courpas, K. Cheung, et al.

Efficacy of postoperative patient-controlled and continous infusion epidural versus intravenous patientcontrolled analgesia with opioids: A meta-analysis.

Anesthesiology, 103 (2005), pp. 1079-1088

Medline

[14.]

J.M. Richman, S.S. Liu, G. Courpas, R. Wong, A.J. Rowlingson, J. McGready, et al.

Does continous peripheral nerve block provide superior pain control to opioids? A meta-analysis.

Anesth Analg, 102 (2006), pp. 248-257

http://dx.doi.org/10.1213/01.ANE.0000181289.09675.7D | Medline

[15.]

C.L. Wu, R.W. Hurley, G.F. Andersen, R. Herbert, A.J. Rowlingson, L.A. Fleisher, et al.

Effect of postoperative epidural analgesia on morbidity and mortality following surgery in medicare patients.

Reg Anesth Pain Med, 29 (2004), pp. 525-533

Medline

[16.]

H. Jorgensen, J. Wetterslev, S. Moiniche, J.B. Dahl.

Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis. PONV and pain after abdominal surgery.

Cochrane Database Syst Rev, 4 (2000),

http://dx.doi.org/10.1002/14651858.CD006520.pub2 | Medline

[17.]

P.S. Hodgson, S.S. Liu.

Thoracic epidural anaesthesia and analgesia for abdominal surgery: Effects on gastrointestinal function and perfusion.

Ballieres Clin Anaesthesiol, 13 (1999), pp. 9-22

[18.]

A. Kortgen, M. Silomon, C. Pape-Becker, H. Buchinger, U. Grudmann, M. Bauer.

Thoracic but no lumbar epidural anaesthesia increases liver blod flow after major abdominal surgery.

Eur J Anaesthesiol, 26 (2009), pp. 111-116

http://dx.doi.org/10.1097/EJA.0b013e32831c8939 | Medline

[19.]

S. Leone, S. Di Cianni, A. Casati, G. Fanelli.

Pharmacology, toxicology, and clinical use of new long acting local anesthetics, ropivacaine and levobupivacaine.

Acta Biomed, 79 (2008), pp. 92-105

Medline

[20.]

G. Brunat.

Posterior perineal block with ropivacaine 0,75% for pain control during after hemorrhoidectomy.

Reg Anaesth Pain Med, 28 (2003), pp. 228-232

[21.]

N. Petterson, P. Berggren, M. Larsson, B. Westman, R.G. Hahn.

Pain relief by wound infiltration with bupivacaine or highdose ropivacaine after inguinal hernia repair.

Reg Anesth Pain Med, 24 (1999), pp. 569-575

Medline

[22.]

V. Lohsriwt, N. Lert-akayamanee, W. Rushatamukyanut.

Efficacity of preincisional bupivacaine or high dose ropivacaine on postoperative pain relief after apendicectomy: Prospective double blind randomized trial.

World J Surg, 28 (2004), pp. 947-950

http://dx.doi.org/10.1007/s00268-004-7471-8 | Medline

[23.]

M.E. Ausems, K.W. Hulsewé, P.M. Hooymans, A.G. Hoofwijk.

Postoperative analgesia requeriments at home after inguinal hernia repair: Effects of wound infiltration on postoperative pain.

Anaesthesia, 62 (2007), pp. 325-331

http://dx.doi.org/10.1111/j.1365-2044.2007.04991.x | Medline

[24.]

K. Jensen, H. Kehlet, C.M. Lund.

Post-operative recovery profile after laparoscopic cholecystectomy: A prospective, observational study of a multimodal anaesthetic regime.

Acta Anaest Scan, 51 (2007), pp. 464-471

[25.]

Clinical outcomes of Surgical Therapy Study Group.

A comparison of laparoscopically assisted and open colectomy for colon cancer.

N England J Med, 350 (2004), pp. 2050-2059

[26.]

J.J. Tjandra, M.K. Chan.

Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer.

Colorectal An, 8 (2006), pp. 375-388

[27.]

R. Veldkamp, M. Gholqhesai, H.J. Bonjer, D.W. Meijer, M. Buunen, J. Jeekel, et al.

Laparoscopic resection of colon cancer: Consensus of the European Association of Endoscopic Surgery (EAES).

Surg Endosc, 18 (2004), pp. 1163-1185

http://dx.doi.org/10.1007/s00464-003-8253-3 | Medline

[28.]

N. van Veen, C. Mahabier, I. Dawson, W.C. Hop, N.F. Kok, J.F. Lange, et al.

Spinal or local anesthesia in lichtenstein hernia repair: A randomized controlled trial.

Ann Surg, 247 (2008), pp. 428-433

http://dx.doi.org/10.1097/SLA.0b013e318165b0ff | Medline

[29.]

P. Nordin, H. Hernell, M. Unosson, U. Gunnarsson, E. Nilsson.

Type of anaesthesia and patient acceptance in groin hernia repair: A multicentre randomized trial.

Hernia, 8 (2004), pp. 220-225

http://dx.doi.org/10.1007/s10029-004-0234-5 | Medline

[30.]

T. Callesen.

Inguinal hernia repair: Anaesthesia, pain and convalescence.

Dan Med Bull, 50 (2003), pp. 203-218

Medline

[31.]

F.A. Gultekin, O. Kurukahvecioglu, A. Karamercan, B. Ege, E. Ersoy, E. Tatlicioglu.

A prospective comparison of local and spinal anesthesia for inguinal hernia repair.

Hernia, 11 (2007), pp. 153-156

http://dx.doi.org/10.1007/s10029-006-0166-3 | Medline

[32.]

H. Ozgün, M.N. Kurt, I. Kurt, M.H. Cevikel.

Comparison of local, spinal, and general anaesthesia for inguinal herniorrhaphy.

Ur J Surg, 168 (2002), pp. 455

[33.]

B. Vinson-Bonnet, J.C. Coltat, A. Fingerhut, F. Bonnet.

Local infiltration with ropivacaine improves inmediate postoperative pain control after hemorrhoidal surgery.

Dis Colon Rectum, 45 (2002), pp. 104-108

Medline

[34.]

P. Niccolai.

Intérêt de l’infiltration périné ale postérieure en chirurgie proctologique.

Prat Anesth Reanim, 6 (2002), pp. 4

[35.]

P. Alfonsi, E. Schaack.

Accelerated postoperative recovery after colorectal surgery.

J Chir (Paris), 144 (2007), pp. 191-196

[36.]

C. Schmidt, M. Creutzenberg, P. Piso, J. Hobbhahn, M. Bucher.

Peri-operative anaesthetic management of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

Anaesthesia, 63 (2008), pp. 389-395

http://dx.doi.org/10.1111/j.1365-2044.2007.05380.x | Medline

[37.]

P. Feltracco, M.L. Brezzi, S. Barbieri, E. Serra, M. Milevoj, C. Ori.

Epidural anesthesia and analgesia in liver resection and living donor hepatectomy.

Transplant Proc, 40 (2008), pp. 1165-1168

http://dx.doi.org/10.1016/j.transproceed.2008.03.108 | Medline

[38.]

W.A. Macrae.

Chronic post-surgical pain: 10 years on.

Br J Anaesth, 101 (2008), pp. 77-86

http://dx.doi.org/10.1093/bja/aen099 | Medline

[39.]

F.M. Perkins, H. Kehlet.

Chronic pain as an outcome of surgery. A review of predective factors.

Anesthesiology, 93 (2000), pp. 1123-1133

Medline

[40.]

E.J. Visser.

Chronic post-surgical pain: Epidemiology and clinical implications for acute pain management.

Acute Pain, 8 (2006), pp. 73-81

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