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Yale J Biol Med. 2010 Mar;83(1):11-25.

Recent advances in postoperative pain management.

Author information

1
Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut 06511, USA. nalini.vadivelu@yale.edu

Abstract

Good pain control after surgery is important to prevent negative outcomes such as tachycardia, hypertension, myocardial ischemia, decrease in alveolar ventilation, and poor wound healing. Exacerbations of acute pain can lead to neural sensitization and release of mediators both peripherally and centrally. Clinical wind up occurs from the processes of N-Methyl D-Aspartate (NMDA) activation, wind up central sensitization, long-term potentiation of pain (LTP), and transcription-dependent sensitization. Advances in the knowledge of molecular mechanisms have led to the development of multimodal analgesia and new pharmaceutical products to treat postoperative pain. The new pharmacological products to treat postoperative pain include extended-release epidural morphine and analgesic adjuvants such as capsaicin, ketamine, gabapentin, pregabalin dexmetomidine, and tapentadol. Newer postoperative patient-controlled analgesia (PCA) in modes such as intranasal, regional, transdermal, and pulmonary presents another interesting avenue of development.

KEYWORDS:

acute pain; opioids; pain mechanisms; patient-controlled analgesia; postoperative

PMID:
20351978
PMCID:
PMC2844689
[Indexed for MEDLINE]
Free PMC Article

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