Target controlled infusion and post-operative analgesia

During the last decade there has been an explosive increase in the knowledge of basic pain physiology, but the implications for clinical practice have been less substantial. Despite many advances in our understanding of pain, in the development of new drugs and in the introduction of new drug delivery systems, the majority of surgical patients continue to receive inadequate therapy for post-operative pain. Pain is still accepted as a necessary part of the post-operative experience. With the introduction of target-controlled infusion into clinical anaesthesia the controllability of administration of intravenous drugs has been increased. In the post-operative period in particular, precise titration might offer some advantages. Whether these advantages will be clinically relevant remains to be studied. As yet, there is no single agent for the relief of acute post-operative pain that is without adverse effects. It is recognized, however, that acute post-operative pain can be managed safely and effectively with the appropriate use of existing drugs. Ideally acute post-operative pain is treated with an individualized prescription based upon the physiological status of the patient, the extent of surgical injury, the technical possibilities of the caregivers, the economic resources of the hospital, and the will to invest in pain management techniques.