Optimizing perioperative analgesia for the complex pain patient: medical and interventional strategies

Purpose The purpose of this article is to review the literature and to highlight current practice regarding the management of the chronic pain patient presenting for surgery. Principal findings It can be difficult to achieve adequate postoperative analgesia in patients who present for surgery with p...

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Bibliographic Details
Published in:Canadian journal of anesthesia 2014-02, Vol.61 (2), p.131-140
Main Author: Tumber, Paul S.
Format: Article
Language:English
Subjects:
Analgesia - methods
Analgesics
Analgesics - therapeutic use
Anesthesia - methods
Anesthesiology
Anesthetics - administration & dosage
Anesthetics - therapeutic use
Anticonvulsants
Antidepressants
Anxiety
Anxiety - etiology
Cardiology
Chronic pain
Chronic Pain - drug therapy
Critical Care Medicine
Drug dosages
Drug interactions
Fibromyalgia
Humans
Intensive
Ketamine
Local anesthesia
Medical personnel
Medicine
Medicine & Public Health
Narcotics
Ostomy
Pain Medicine
Pain, Postoperative - prevention & control
Patients
Pediatrics
Perioperative Care - methods
Pneumology/Respiratory System
Premedication
Regional anesthesia
Review Article/Brief Review
Surgery
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Summary:Purpose The purpose of this article is to review the literature and to highlight current practice regarding the management of the chronic pain patient presenting for surgery. Principal findings It can be difficult to achieve adequate postoperative analgesia in patients who present for surgery with preexisting chronic pain. Such complex pain patients require a care plan that involves preoperative, intraoperative, and postoperative considerations. Preoperatively, it is important to identify these patients’ specific concerns, to address anxiety, to review expectations of care, and to consider premedication. Intraoperatively, it is important to consider local anesthetic regional anesthesia techniques and to supplement as necessary with pharmaceutical agents, e.g., ketamine, dexamethasone, ketorolac, and opioids. Postoperatively, it is important to continue multimodal analgesia techniques. It is vital to maintain a healthy therapeutic alliance with the patient and with allied health professionals. Nonspecific treatment effects can bolster efforts to achieve adequate analgesia. Conclusion Successful management of the complex pain patient requires knowledge of the art and science of perioperative medicine.
ISSN:0832-610X
1496-8975
DOI:10.1007/s12630-013-0073-x