[Postoperative patient management. Pain after surgical intervention].

A MAJOR CHALLENGE: Management of post-operative pain is insufficient. One out of 2 patients suffers intense or very intense pain during the first days after surgery. The inefficacy of analgesic therapy is related to lack of a sufficiently organized pain-relief protocol. Patients are insufficiently informed, prescriptions lack precision, postoperative pain is not regularly evaluated, and patient controlled analgesia (PCA) and loco-regional techniques are insufficiently applied. NECESSARY STEPS: Pain relief protocols in surgery units should be organized in a stepwise fashion. The first step is to record the patient's level of pain every 8 hours during the first 5 days after surgery. The second step is to define the role of each health carer in the implementation of analgesic techniques. The third step is to develop adapted analgesic techniques (paracetamol and anti-inflammatory drugs, subcutaneous morphine, PCA and loco-regional techniques, particularly peripheral blocks for orthopedic surgery). The final step is an evaluation phase aimed at assessing the impact on the management of postoperative pain in the unit. LOW COST: Optimally, the entire procedure, integrated into an overall quality assurance program, is directed by one reference physician assisted by a nurse specially qualified in pain relief. The overall financial burden, including drug costs, material and health care personnel is minimal. In French units, it has been estimated at around 10 to 20 F per patient per day.