What are the options for postoperative pain control?

What are the options for postoperative pain control?

Patient-controlled analgesia (PCA) with opioids, such as morphine sulfate or fentanyl, is an appropriate choice for postoperative pain control in the absence of indwelling catheters (epidural or femoral-sciatic). While PCA pro-vides patients with better control of their pain, it is associ-ated with nausea and vomiting that may need treatment. In addition, older patients may be more sensitive to the effects of the opioid and may become heavily sedated and ulti-mately apneic. Appropriate PCA settings and monitoring are necessary for the safe administration of a PCA in these patients.

The placement of an epidural catheter has the advan-tage in that it allows for the administration of an opioid and/or local anesthetic. However, nausea, vomiting, and itching may occur. In addition, the use of anticoagulation and antiplatelet medications in the postoperative period has to be coordinated with removal of the epidural catheter.

Intrathecal opioids can provide excellent pain control but they only last up to 24 hours. Nausea, vomiting, and itching may occur as well with this modality.

Femoral and sciatic catheters provide excellent pain control but their use needs to be coordinated with the patient’s physical therapy program. Otherwise, the patient may not have adequate motor function at a time when it is important to be able to move the operative extremity.