Although efficient treatment of post-surgical pain is considered to be a
pre-condition for a normal course of the post-surgical period, epidemiological and clinical research show that a significant number of patients still suffer intense pain after major surgery. Intense nociceptive somatic and visceral post-surgical pain has in the last ten years been considered the most important development of endocrine and neurohumoral disorders in the immediate post-surgical period, (the vital organ functional disorders, occurence of serious ostoperative complications and prolonged hospitalisation.) The effects
of successful perioperative analgesia on the course and outcome of surgical patients remains disputable, particularly because there is no consensus on the optimal procedure for specific pain therapy. The multimodal analgesia (defined as use of NSAIDs, COX–2 inhibitors or paracetamol in combination with i.v. opioid PCA ) results in an opioid sparing effect. However, this opioid reduction does not consistently result in decreased opioid side effects. The overall negative outcome effects by i.v. opioids PCA correspond well with minor effects on postoperative dynamic pain, stress response and organ dysfunctions. At present the entire role of perioperative epidural technique
on patient outcome is unclear. Also, the advantages of epidural analgesia have to be balanced against their risk and cost. The concept of multi-modal analgesia is an area of most importance and where future research efforts should focus on the combination of several techniques such as continuous peripheral nerve-blocks, continuous wound-infusion of local anaesthetics, NSAIDs/COX-2 inhibitors, paracetamol, α-2 agonists, ketamine, dextromethorphane, gabapentin/pregabalin, glucocorticoids etc
