Acute postoperative pain management: Past, present, and future

Although postoperative pain control is essential for patient care, many patients after surgery experienced distressing pain until recently. At present, however, adequate pain control can be achieved in most patients after major abdominal surgery by applying continuous epidural analgesia with a local anesthetic-opioid combination, using portable disposable infusors or PCA pumps. In patients undergoing such painful surgery as major orthognathic surgery under general anesthesia alone, intravenous PCA opioids provide the best postoperative pain control. Clinically, interindividual differences in pain sensitivity and opioid sensitivity often hamper effective pain control. Elucidation of genetic mechanisms underlying such interindividual differences will lead to better understanding and hence better control of postoperative pain in the future.