Effect of postoperative pain treatment on outcome - current status and future strategies

Background and aims. The effect of postoperative pain relief on morbidity and hospital stay is reviewed. Results. Beneficial effects of postoperative pain relief by patient-controlled analgesia (PCA) opioids on morbidity and hospital stay have not been documented. The clinical outcome effects of the 20%-30% opioid sparing by non-steroidal anti-inflammatory agents have not been defined, but recent data suggest hastened recovery in cholecystectomy and knee surgery. The effect of continuous epidural analgesia on morbidity and hospital stay remains controversial except for improved pulmonary outcome. However, existing randomised trials on continuous epidural analgesia have insufficient design due to predominantly opioid-based epidural analgesia and the lack of a revision of perioperative care programmes to take advantage of the beneficial physiological effects of balanced epidural analgesia. Conclusion. The effects of pain relief on outcome remains debatable, despite beneficial effects of pathophysiological responses. Future outcome studies are required where optimised dynamic pain relief is integrated with a multimodal rehabilitation programme.