Recent advances in postoperative pain therapy

Despite many advances in the provision of pain services, acute pain after surgery remains a serious cause of severe suffering that is often undermanaged despite our best efforts.6 34 37 Acute pain teams have been introduced in many hospitals, but recent evidence from a UK national postal questionnaire suggests that they are struggling with the problem of alleviating acute pain successfully.90 In a review of published data of pooled pain scores from nearly 20 000 surgical patients having intramuscular, patient controlled analgesia (PCA) or extradural analgesia, the over-all mean (95 % confidence interval) incidence of moderate to severe and severe pain was 29.7 (26.4–33.0) % and 10.9 (8.4– 13.4)%, respectively.37 Often the provision of effective post-operative analgesia is limited by side-effects, and these have been quantified in contemporary anaesthetic practice b