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KEYWORDS Analgesia / Anti-inflammatory drugs / NSAIDs / COX-2s / Paracetamol / Postoperative pain / Pharmacology
Successful management of acute post-operative pain in the post anaesthesia care unit (PACU) is vitally important. A multimodal approach incorporating analgesics with varying sites of action is recommended. Anti-inflammatory drugs are effective analgesics in the treatment of mild to moderate acute pain (Bandolier Oxford league table of analgesic efficacy 2007). The purpose of this article is to consider the evidence for the use of non-steroidal anti-inflammatory drugs (NSAIDs) for acute postoperative pain.
Introduction
The International Association for the Study of Pain (IASP) defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" (IASP 1979). During surgery tissue damage is unavoidable and causes changes in the peripheral and central nervous system, which in turn produce reversible pain hypersensitivity in the inflamed and surrounding tissue (Warfield et al 2004). This sensation of pain then helps to protect the area from further damage until wound healing has occurred. In this way acute pain has a protective role and is usually short lived. Unfortunately for some this is not the case: the hypersensitised pain state can lead to the development of chronic pain. The association between surgery, acute postoperative pain and ongoing chronic pain (unexpected pain beyond three months) is well defined (Poobalan et al 2003, Nikolajsen et al 2004).
Acute postoperative pain is accompanied by an emotional response and an autonomic response and both contribute to a physiological response which may disrupt the healing process. The physiological consequences of acute postoperative pain include: muscle splinting and an inability to cough, effectively leading to retained secretions and impaired respiratory function; tachycardia and hypertension leading to increased myocardial work and oxygen consumption; intestinal motility slows and endocrine effects can result in hyperglycemia and retention of sodium and water (this has been implicated as a cause of anastomotic failure in the postoperative period). Immobility from acute postoperative pain increases patients' risk of deep vein thrombosis and pulmonary embolism. Inadequate management of acute post-operative pain contributes to discomfort and distress, postoperative morbidity and increased hospital stay (American Society of Anesthesiologists 2004). It is therefore vitally important that acute postoperative pain is...