Acute Pain Medicine: Novel Analgesic Techniques

Abstract

Patients with postoperative pain continue to have unmet needs. Despite guidelines for pain management and improving technology, patient experiences with pain have not significantly improved after surgery. Although more effective application of current therapies would likely improve patient experience, available technologies still leave much to be desired. Although effective, intravenous patient-controlled analgesia (IV-PCA) is a burdensome technology. Further, medication errors, pump programming errors, and other technology-related problems may lead to patient injury and under or over dosing. Continuous epidural analgesia by catheter has frequent failures and it requires a high level of staffing. Moreover, recent efforts to reduce the incidence of postoperative venous thromboembolism by the use of anticoagulants has placed limitations on the use of indwelling epidural catheters. No large series have examined the failure rates of continuous peripheral nerve blocks. Current standard therapies in postoperative pain management largely depend on cumbersome technologies requiring pumps and indwelling catheters. In addition to the opportunities for failure and medical errors, these technologies are inherently complex and place a heavy labor burden on the healthcare team. Patients spend an inordinate amount of time tethered to equipment that limits ambulation, physical therapy, and activities of daily living. Opioids remain commonly used in postoperative pain management. Unfortunately, the well-known side effects (nausea, vomiting, sedation, respiratory depression, confusion, constipation) are not only dangerous but cause significant patient misery. Patients treated with opioids typically attempt to find a balance between analgesia and side effects. Patients will often choose less complete pain relief to avoid opioid side effects. Almost all patients require parenteral therapy at some point during the perioperative period. Unfortunately, the choices for injectable nonopioid pain therapies are limited. Clearly, improvements are needed. There is ample room for new and emerging technologies.