FORUM Postoperative patient management- how can we make progress? Hinnerk Wulf, MD, PhD 0) Stephan A Schug, MD, FANZCA (2) 1Ken6e Allvin, CRNA (3) Henrik Kehlet, MD (4) Figure 1: Landmarks in analgesia .... 7 1800 .8 J ANALGESICS AND LOCAL ANAESTHETICS ¢ 8 8 I 1850 d :6" ~_ 1900 / 3 ' 010 1950 2 0 TECHNIQUES AND MANAGEMENT 8 Introduction On 3 July 1998 an expert panel of speakers assemb- led for a special forum* at the European Congress of Anaesthesiology, Frankfurt, Germany, to discuss the current issues surrounding postoperative patient care, with particular reference to optimising analgesia. (1) Department of Anaesthesiology and Intensive Care, Hospital of the Christian-Albrechts-University of Kiel, Germany. (2) Section of Anaesthetics, Department of Pharmacology, University of Auckland, New Zealand. (3) Department of Anaesthesiology and Intensive Care, Orebro Medical Centre Hospital, Sweden. (4) Depart- merit of Surgical Gastroenterology 235, Hvidovre University Hospital, Denmark. It is clear that there has been considerable progress in postoperative patient care over the years, for example the introduction of acute pain service (APS) units in hospitals. Figure 1 presents a brief summary of the major developments in analgesia since the first use of morphine, in 1804. The beneficial impact of recent developments is illustrated by two surveys conducted among surgical patients at the University Hospital, Kiel) In 1985, an APS was established. In 1989, when questioned about the severity of their pain on the second postoperative day, 71% of those patients not managed by an APS answered 'moderate' and 19% 'severe'. In contrast, in 1994 after the implementation of guidelines in the department, 73% of patients rated their pain severity as 'low' and only 6% of patients 32 Volume 1 (4) September 1998 Acute Pain