from Section 4 - Walking the Walk (and Talking the Talk)
Published online by Cambridge University Press: 09 June 2025
Postoperative patients require analgesia, not only for humanitarian and psychological reasons, but also because to reduce the autonomic responses to pain, to encourage mobilization including deep breathing, as well eating and drinking. Ultimately this may contribute towards reduced incidence of deep vein thrombosis and an earlier return to normal life style/work.
There are a number of common agents used for postoperative analgesia, that have different mechanisms of action. These major drugs include nonsteroidal anti-inflammatory drugs, paracetamol, local anaesthetics and opioid drugs. Less commonly used agents are corticosteroids, ketamine, magnesium, gabapentinoids, alpha2 agonists as well as non-pharmacological methods such as acupuncture and TENS.
Although opioids provide excellent analgesia, they have a number of side effects and the concept of using drugs that work by different mechanisms of action that also reduce the dose of morphine required. This is referred to as ‘multimodal opioid sparing analgesia’ and is the major principle underpinning postoperative analgesia.
There are many factors that influence how postoperative pain is perceived by patients. These include age, sex, preoperative analgesia and chronic pain conditions, as well as the surgery and intraoperative analgesia.
Pain is managed according to the WHO pain ladder and assessed in terms of functional activity rather than a pain score. There are side effects of all analgesics, and these must be balanced against their proposed benefits.
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