Update on perioperative pain management.

State of the art techniques for perioperative pain management in orthopaedic surgery have evolved from cumulative advances in basic sciences, technology, psychology, and changes in physician and nursing practices. Each advance in the understanding of pain physiology and pharmacology and the pain experience has suggested more effective strategies for intervention. Core techniques in perioperative pain management for orthopaedic surgery include intravenous patient controlled analgesia, spinal analgesia, nerve blocks, and appropriate use of nonnarcotic, adjuvant analgesic drugs. Coincident with an increase in demand for these services has been the evolution of interdisciplinary pain management teams commonly known as the Acute Pain Treatment Service. In the context of the national debate on health care reform, research priorities in the field include documentation of impacts on patient outcomes, and influences on the cost of health care.