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

被引:59
作者
Kehlet, H [1 ]
机构
[1] Hvidovre Univ Hosp, Dept Surg Gastroenterol 435, DK-2650 Hvidovre, Denmark
关键词
postoperative pain; morbidity and hospital stay; epidural analgesia; non-steroidal antiinflammatory agents; opioids;
D O I
10.1007/s00423-004-0460-4
中图分类号
R61 [外科手术学];
学科分类号
摘要
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.
引用
收藏
页码:244 / 249
页数:6
相关论文
共 31 条
[11]   Epidural anaesthesia and analgesia - effects on surgical stress responses and implications for postoperative nutrition [J].
Holte, K ;
Kehlet, H .
CLINICAL NUTRITION, 2002, 21 (03) :199-206
[12]   Perioperative single-dose glucocorticoid administration: Pathophysiologic effects and clinical implications [J].
Holte, K ;
Kehler, H .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2002, 195 (05) :694-712
[13]  
HOLTE K, 2003, EVIDENCE BASED RESOU, P175
[14]  
JORGENSEN H, 2002, COCHRANE LIB
[15]   Postoperative opioid analgesia: Time for a reconsideration? [J].
Kehlet, H ;
Rung, GW ;
Callesen, T .
JOURNAL OF CLINICAL ANESTHESIA, 1996, 8 (06) :441-445
[16]   Anaesthesia, surgery, and challenges in postoperative recovery [J].
Kehlet, H ;
Dahl, JB .
LANCET, 2003, 362 (9399) :1921-1928
[17]   Multimodal strategies to improve surgical outcome [J].
Kehlet, H ;
Wilmore, DW .
AMERICAN JOURNAL OF SURGERY, 2002, 183 (06) :630-641
[18]   Multimodal approach to control postoperative pathophysiology and rehabilitation [J].
Kehlet, H .
BRITISH JOURNAL OF ANAESTHESIA, 1997, 78 (05) :606-617
[19]   Effect of postoperative analgesia on surgical outcome [J].
Kehlet, H ;
Holte, K .
BRITISH JOURNAL OF ANAESTHESIA, 2001, 87 (01) :62-72
[20]  
Kehlet H, 1998, NEURAL BLOCKADE CLIN, P129