Dolor agudo postoperatorio

Abstract

Despite advances in the knowledge of acute pain mechanisms and the development of analgesic drugs and techniques for their administration, the prevalence of postoperative pain continues to be high in hospitals. The concepts of primary and secondary hyperalgesia provoked in surgically injured tissues, and the neuroplastic changes that are produced by sustained intensive acute pain, have oriented postoperative pain treatment to act earlier at distinct sites, known as multimodal and pre-emptive analgesia respectively. Opioid administration at spinal level, associated or not to local anaesthetics and the intravenous or epidural patient controlled analgesia modalities are associated with very efficacious analgesia using lower doses of analgesics. Pain level assessment should be incorporated to the controls performed routinary by the nurses in the wards who must be able to recognize and immediately treat complications of the treatment. Postoperative acute pain treatment needs organized resources, including staff, technical equipment and agreed protocols. This can only be obtained within an acute pain service adequate for each type of hospital.