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Acute Post-Surgical Pain Management: A Critical Appraisal of Current Practice
  1. James P. Rathmell, M.D.,
  2. Christopher L. Wu, M.D.,
  3. Raymond S. Sinatra, M.D., Ph.D.,
  4. Jane C. Ballantyne, M.D., F.R.C.P.,
  5. Brian Ginsberg, M.D.,
  6. Debra B. Gordon, R.N.,
  7. Spencer S. Liu, M.D.,
  8. Frederick M. Perkins, M.D.,
  9. Scott S. Reuben, M.D.,
  10. Richard W. Rosenquist, M.D. and
  11. Eugene R. Viscusi, M.D.
  1. University of Vermont College of Medicine, Burlington, VT Johns Hopkins University, Baltimore, MD Yale University School of Medicine, New Haven, CT Massachusetts General Hospital, Boston, MA Duke University, Durham, NC University of Wisconsin Hospital & Clinics, Madison, WI Virginia Mason Medical Center and University of Washington School of Medicine, Seattle, WA Dartmouth Medical School, Hanover, NH Tufts University School of Medicine, Springfield, MA University of Iowa, Iowa City, IA Thomas Jefferson University, Philadelphia, PA
  1. Reprint requests: James P. Rathmell, M.D., Professor of Anesthesiology, University of Vermont College of Medicine, Director, Center for Pain Medicine, Fletcher Allen Health Care, 62 Tilley Drive, South Burlington, VT 05403. E-mail: james.rathmell{at}


The Acute Pain Summit 2005 was convened to critically examine the perceptions of physicians about current methods used to control postoperative pain and to compare those perceptions with the available scientific evidence. Clinicians with expertise in treatment of postsurgical pain were asked to evaluate 10 practice-based statements. The statements were written to reflect areas within the field of acute-pain management, where significant questions remain regarding everyday practice. Each statement made a specific claim about the usefulness of a specific therapy (eg, PCA or epidural analgesia) or the use of pain-control modalities in specific patient populations (eg, epidural analgesia after colon resection). Members of the American Society of Regional Anesthesia and Pain Medicine (ASRA) were asked, via a Web-based survey, to rate their degree of agreement with each of the 10 statements; 22.8% (n = 632) of members responded. In preparation for the pain summit, a panel member independently conducted a literature search and summarized the available evidence relevant to each statement. Summit participants convened in December 2005. The assigned panel member presented the available evidence, and workshop participants then assigned a category for the level of evidence and recommendation for each statement. All participants then voted about each statement by use of the same accept/reject scale used earlier by ASRA members. This manuscript details those opinions and presents a critical analysis of the existing evidence supporting new and emerging techniques used to control postsurgical pain.

  • Acute postoperative pain
  • Patient-controlled analgesia
  • Regional analgesia
  • Epidural analgesia

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