Introduction
The focus of this chapter is on the word “analgesia,” as used in the title. Although
the traditional role of the anesthesiologist is to provide anesthesia, or total pain
relief, for surgical procedures in the operating room, it is no longer possible to
be considered a “compleat” anesthesiologist by ending patient care at the time that
the surgical patient is turned over to the recovery room nurse. There is a growing
specialty and societal expectation that the anesthesiologist will smooth the pathway
for recovery by using specific drugs and techniques to control postoperative pain.
Usually the postoperative period includes a period of 1 to 5 days.
Why has the treatment of postoperative pain become such an issue? Can postoperative
pain be effectively controlled in a more cost-effective manner than through the use
of parenteral narcotics? In reality, narcotic drugs are not a cheap or effective approach.
For example, any patient or nurse who has experienced post-thoracotomy pain control
via the epidural route vs parenteral injections will testify to a preference for the
epidural.1,2 When pain treatment is effective, there are multiple physiologic and economic spin-offs,
such as better wound healing, decreased pulmonary infection rates, improved gastrointestinal
function, shortened hospitalization time, and considerable savings of health care
dollars.3-7
