Page 125 Guide to Pain Management in Low-Resource Settings

Pain Management after Major Surgery 113

• Treatment of pain may, however, cause its own • International and national drug regulatory bodies
problems and should be planned and practiced in partnership with governments and local sup-
with clear written guidelines and protocols. pliers should make opioids more available and
• Education and involvement of the patient, the reduce restrictions on their use for pain manage-
family, and all medical staff are all important for ment in developing countries.
any pain management program to succeed.
• Universal acute pain management protocols and
References
guidelines need to be encouraged by WHO and
other professional and regulatory bodies. Region- [1] Allman KG, Wilson I, editors. Oxford handbook of anaesthesia, 2nd ed.
New York: Oxford University Press; 2006.
al and local modifi cations will be required to re- [2] Amata AO, Samaroo LN, Monplaisir SN. Pain control after major sur-
fl ect the type of patients and the type of surgery, gery. East Afr Med J 1999;76:269–71.
[3] Matta JA, Cornett PM, Miyares RL, Abe K, Sahibzada N, Ahern GP.
as well as the resources available. General anesthetics activate a nociceptive ion channel to enhance pain
• Even in poorly resourced countries, eff orts and infl ammation. Proc Natl Acad Sci USA 2008;105:8784–9.
[4] Scott NB, Hodson M. Public perceptions of postoperative pain and its
should be made to provide enough funds to im- relief. Anaesthesia 1997;52:438–42.
[5] Wheatley RG, Madej TH, Jackson IJ, Hunter D. Th e fi rst year’s experi-
prove standards of postoperative care, especially ence of an acute pain service. Br J Anaesth 1991;67:353–9.
pain management.
• All medical personnel should be trained to over- Websites
come the fear of strong opioid analgesics and
other methods of pain relief, and to develop a www.anaesthesia-az.com
Anesthesia, pain, and intensive care management
positive attitude toward all patients who have had
www.postoppain.org
major surgery. Good site for pain management in ideal situations
• More use of local anesthetic drugs and tech- www.nda.ox.ac.uk/wfsa
niques, and also the use of peripheral analgesics, Updates aimed at poorly resourced countries
www.who.int/medicines
should be encouraged after all types of surgery. Drug policies and control, including essential drugs list