الفهرس 
Pathophysiology of PainOnly 14 pages are availabe for public view
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Abstract
D
evelopment of chronic postsurgical pain syndromes, hyperalgesia and immunomodulation are some particular concerns as they may be related to opioid exposure, intertwined with patient characteristics and other factors. Application of a multimodal approach, administration of preventive analgesia and paradigm shift in surgical techniques all mandate a revisit of evidence-based perioperative pain management.
Inadequate treatment of postoperative pain continues to be an important clinical problem, not only leading to worse outcomes in the immediate postoperative period but also an increased risk for persistent postoperative pain.
Multimodal pain management combines the use of different pharmacologic mechanisms of action and additive or synergistic effects, which work by acting at different sites within the central and peripheral nervous system .The goal is to provide optimal pain control, limit the amount of opioids required after surgery, and therefore, decrease their associated adverse effects.
Pregabalin is a novel drug in which there has been heightened research interest with respect to its analgesic, sedative, anxiolytic and opioid-sparing effects in various pain settings, including postoperative pain. Its main advantage over gabapentin may be a faster onset and reduced adverse effects.
As the recent ASA Task Force on Acute Pain Management guidelines clearly emphasize a multimodal approach to analgesia in the perioperative setting, regional analgesia has a clear role in reducing postoperative pain in the PACU and should be used whenever possible. Regional analgesia has been demonstrated to be superior to opioids in the management of postoperative pain, especially in the orthopedic populations.
Numerous perineural adjuvants have been used with local anesthetics in regional anesthesia in an attempt to optimize block characteristics and improve clinical outcomes such as: Vasoconstrictors, α2-Adrenergic Agonists, Dexamethasone, Ketamine, Magnesium sulphate and Midazolam. The ideal adjuvant that acts to prolong anesthesia and improve clinical outcomes while maintaining a favorable side effect profile, remains undiscovered.
The use of ultrasound has become enormously popular within the context of regional anesthesia. Ever since its introduction in regional anesthesia, a number of articles have been published contributing modifications to the classic approaches that donot use ultrasound as a guide.
The field of pain management is ideal for the incorporation of computer and/or robotic assistance in its procedures. Most of the procedures entail delivering the treatment via small access points. The goal of reducing tissue trauma makes it even more challenging to reach the targeted location. The use of computer and/or robotics will allow for precision, accuracy and reproducibility.
The current study concludes the necessity of using the multimodal analgesia and preoperative dosing of non-opioid analgesics and advocates for local anesthetic and regional anesthetic techniques whenever possible.
This represents a paradigm shift whereby non opioid analgesics become the cornerstone, with preoperative and around-the-clock dosing with opioids used as adjunctive analgesics on an as-needed basis.