Changes in Postoperative Analgesia

Postoperative pain management has changed with the evolution of surgical techniques. Epidural anesthesia was a very useful method of postoperative analgesia when laparotomy or thoracotomy was performed by making a large skin incision in the abdomen or chest. Nowadays, surgeries are often performed through very small skin incisions using laparoscopy or thoracoscopy. Furthermore, surgeries are often performed on elderly patients, and in many patients, anticoagulants are used in preoperative period and continued during intraoperative period or started early in postoperative period, and there are concerns that epidural anesthesia cannot be performed, or that epidural anesthesia may delay the start of early postoperative anticoagulation in such patients; hence, there is a tendency to avoid epidural anesthesia. In such cases, intravenous administration of patient-controlled analgesia (PCA) fentanyl is an effective method of postoperative analgesia. We will discuss the advantages and disadvantages of intravenous (IV)PCA and epidural anesthesia and also the combined use of peripheral nerve blocks, which has been in the spotlight in recent years. Early postoperative mobilization is useful in preventing muscle weakness and delirium. What we require today are postoperative analgesics that provide rapid postoperative recovery and do not cause nausea and vomiting.