Postoperative pain management

The importance of perioperative pain management (POPM) has recently drawn increased attention, and pain is considered to be a fifth vital sign in some healthcare institutions in Korea. Developments in POPM over the years include patient-controlled analgesia, multimodal analgesia and the establishment of acute pain service units. Over time, the prevalent approach of preemptive analgesia has changed to one of preventive analgesia. Recently developed guidelines for POPM emphasize the importance of multimodal analgesia. Using more than two analgesic drugs that have different mechanisms or act on different receptors is more effective in postoperative pain control and is associated with reduced incidence of adverse effects. In addition, multimodal analgesia involves routes of administration other than oral and intravenous, such as central regional analgesia and peripheral nerve blocks. While developments in the technological and pharmacological approaches to multimodal analgesia continue to occur, new challenges have arisen, such as chronic post-surgical pain and acute neuropathic pain in acute pain service units. Despite the existence of many guidelines for POPM, many patients continue to complain of pain after surgery. Evidence-based, procedure-specific pain management represents a promising new concept. POPM must be considered as part of a process aimed at achieving fast-track surgery that facilitates early discharge and more rapid resumption of normal activities of living. Here, we review the recent guidelines and discuss possible causes of insufficient postoperative pain control.