7/28/2019 Evidence-Based Management of Postoperative Pain

1/1

Evidence-based management of postoperative pain

Stephan A. Schug, MD(Cgn), FANZCA, FFPMANZCA

Professor of Anaesthesiology, Pharmacology and Anaesthesiology Unit, University of Western Australia & Director of Pain Medicine, Royal Perth Hospital

Many patients after surgery and trauma continue to suffer unnecessary pain due to insufficienttreatment. The reason for this is obviously that advances in knowledge do not necessarily lead to thesame degree of progress in patient care. This lecture will try to present two ways of collecting updatedevidence for the management of acute pain and disseminating it in a concise form to all healthcarepractitioners.

The first one is the development of the document Acute Pain Management: Scientific Evidence, whichwas published in an initial version by the National Health and Medical Research Council of Australia(NHMRC) in 1999. This document has been updated by the Australian and New Zealand College of

Anaesthetists and its Faculty of Pain Medicine; the document, then published in 2005 in the form of apaperback book (1) and PDF file on a website (www.anzca.edu.au/publications/acutepain.htm), hasnot only been endorsed by the NHMRC, but has nearly become the international standard withendorsements by the Australian Pain Society, the Royal College of Anaesthetists, the International

Association for the Study of Pain and recommendation by the American Academy of Pain Medicine.

Another avenue to summarise evidence on acute pain management has been taken by the membersof the PROSPECT website. This approach recognises that different surgical procedures may result indifferent types of pain, different intensities of pain and different locations of pain. It is quite obviousthat such differences lead to different risk/benefit ratios for different analgesic techniques in thevarious postoperative settings. The PROSPECT approach has followed this guidance and aims toprovide healthcare professionals with procedure-specific information that is up-to-date and evidencebased (2). The recommendations are presented on a website ( www.postoppain.org ) and providerecommendations for best practice accessible to everybody on this website with a user-friendlyinterface. The methodology underlying the PROPSECT recommendations is published in the peer-reviewed literature (3). The final recommendations for a procedure are presented in the form of a flowdiagram.

References:1. Australian and New Zealand College of Anaesthetists, Faculty of Pain Medicine. Acute painmanagement: scientific evidence. 2nd ed. Melbourne: Australian and New Zealand College of

Anaesthetists; 2005.2. Kehlet H, Wilkinson RC, Fischer HB, Camu F. PROSPECT: evidence-based, procedure-specific postoperative pain management. Best Pract Res Clin Anaesthesiol. 2007 Mar;21(1):149-59.3. Neugebauer EA, Wilkinson RC, Kehlet H, Schug SA. PROSPECT: a practical method for formulating evidence-based expert recommendations for the management of postoperative pain. SurgEndosc. 2007 Feb 9;21(7):1047-53.

http://www.postoppain.org/http://www.postoppain.org/