Abstract
Many studies demonstrated that the treatment of postoperative pain is still suboptimal and approximately one third of patients after surgery suffer from strong or sever pain. Essential part of successful therapy is measurement of intensity of pain and the effect of analgesic therapy.
Multimodal analgesia is used do decrease side effects of individual drugs, mainly opioids. The results of meta-analyses confirm that the most frequently used and the safest analgesics are paracetamol and metamizol (dipyrone).
Non-steroidal anti-inflammatory drugs are not recommended, because of their potentially serious side effects like postoperative bleeding or in some drugs renal failure. Important role in the treatment of acute and chronic pain has ketamine.
Other adjuvant drugs have not proved their efficacy except of systemic lidocaine; gabapentinoids should not be used in this indication at all. Opioid therapy remains the cornerstone of postoperative pain treatment.
There are some new opioids under development or new modification of old molecules mainly to prolong their effect (morphine, bupivacaine); new methods of patient controlled analgesia are used. Very important component of multimodal analgesia are loco-regional methods.
Recent trend is changing strategy of administration of local anaesthetics from centre to periphery: from epidural catheters to more peripheral blocks and finally to single shot or continuous local infiltration.