Page 34 Acute Pain Management

4. Ketamine, lignocaine (lidocaine), tramadol and amitriptyline reduce stump pain (S)
(Level II).
5. Perioperative epidural analgesia reduces the incidence of severe phantom limb pain (U)
(Level III‐2).

 Perioperative ketamine may prevent severe phantom limb pain (U).
Other postoperative pain syndromes
1. Perioperative epidural analgesia reduces the incidence of post‐thoracotomy pain
syndrome (N) (Level II).
SUMMARY 3. thoracotomy pain syndrome (N) (Level II).
2.
Cryoanalgesia for thoracotomy relieves postoperative pain but increases the risk of post‐
Preincisional paravertebral block and perioperative use of gabapentin, mexiletine and/or
eutectic mixture of local anaesthetic reduce the incidence of postmastectomy pain (N)

Post‐thoracotomy, postmastectomy, postherniotomy and posthysterectomy pain
4. (Level II).
syndromes occur frequently (N) (Level IV).
Day‐stay or short‐stay surgery
1. Infiltration of the wound with local anaesthetic agents provides good and long‐lasting
analgesia after ambulatory surgery (U) (Level II).
2. Peripheral nerve blocks with long‐acting local anaesthetic agents provide long‐lasting
postoperative analgesia after ambulatory surgery (U) (Level II).
3. Single shot infraclavicular blocks provide effective analgesia and less nausea following
hand and wrist surgery and earlier ambulation and hospital discharge compared with
general anaesthesia (N) (Level II).
4. Continuous peripheral nerve blocks provide extended analgesia after ambulatory surgery
(U) (Level II), leading to reduced opioid requirements, less sleep disturbance, earlier
achievement of discharge criteria and improved rehabilitation (N) (Level II).
5. Continuous peripheral nerve blocks have been shown to be safe at home, if adequate
resources and patient education are provided (U) (Level IV).
6. Pain relief after ambulatory surgery remains poor (N) (Level IV) and is a common cause of
unplanned readmissions (N) (Level III‐3).
Cranial neurosurgery
1. Morphine is more effective than codeine and tramadol for pain relief after craniotomy
(N) (Level II).
2. Local anaesthetic infiltration of the scalp provides early analgesia after craniotomy and
reduces incidence of subsequent chronic pain (N) (Level II).
3. Craniotomy leads to significant pain in the early postoperative period (N) (Level IV),
which is however not as severe as pain from other surgical interventions (N) (Level III‐2).
4. Craniotomy can lead to significant chronic headache (N) (Level IV).

xxxiv Acute Pain Management: Scientific Evidence