AANA Journal course: new technologies in anesthesia: update for nurse anesthetists--alternatives for postoperative pain management.

Conventional intramuscular or intravenous opioid therapy provides less than optimal postoperative analgesia in many situations. Recent advances allow a more rational administration of narcotic agents and a more individualized approach to patient analgesic requirements. In this lesson, current concepts of pain physiology will be covered, including afferent pain pathways, the descending modulation of nociception traffic and the neurohumoral stress response. A discussion of selected alternatives to traditional postoperative pain management techniques will be presented. Descriptions of spinal opioid therapy and patient-controlled analgesia (PCA) will include the pharmacology and complications of these techniques. The potential for idealized postoperative pain management to alter the neurohumoral stress response to tissue injury, and thereby affect perioperative outcome, will be explored.