Preface

Postoperative pain (POP) is a health problem that has not yet been resolved. Without a doubt, multimodal analgesia is the greatest advance in the prevention and comprehensive management of patients with POP. Despite this advance, healthcare professionals require more knowledge to effectively manage POP since its deleterious effects manifest not only in the immediate post-surgical phase but can also be prolonged as postoperative chronic pain that is difficult to manage and interferes substantially with patient quality of life. In addition, poorly treated POP facilitates prolonged stays and/or hospital readmissions that increase care costs.

Opioids have long been the basis for the management of post-surgical pain. However, the overprescription of these drugs and their illegal use have led to the current opioid crisis worldwide, which has caused more than 96,700 deaths in the United States. The current trend is to reduce the use of opioids in pain management as well as search for new opioids with fewer side effects.

*Topics in Postoperative Pain* presents some selected subjects with the goal of improving the care of surgical patients and reducing both the sequelae of POP and the side effects of its management.

The editors of this book completed residencies at the same hospital, at very different times, with teachers and changing programs that have gradually adapted to the academic and care needs of our alma mater, the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. As graduates from the Division of Anesthesiology and Critical Care Medicine, we know about the goals, challenges, successes, and failures of the founders of our group and we wish to dedicate this book to them: Javier Ramírez Acosta, Ramon De Lille Fuentes, J. Antonio Jimenez Borreiro, and Gabriel Camacho Romero began training specialists in anesthesiology and critical medicine in 1972.

Thank you very much for your wisdom, your dedication, and above all your valuable friendship!

> **Victor M. Whizar-Lugo** Anesthesiologist, Lotus Med Group, Institutos Nacionales de Salud, Tijuana, México

### **Guillermo Domínguez-Cherit**

School of Medicine and Health Sciences, School of Medicine, Monterrey Institute of Technology and Advanced Studies (ITESM), Ciudad de México, México

National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico

#### **Marissa Minutti-Palacios**

Faculty of Medicine, Anesthesia Department, Hospital ABC, Monterrey Institute of Technology and Higher Education, Ciudad de México, México

#### **Analucía Domínguez-Franco**

**1**

surgery.

tion of patients.

**Chapter 1**

**1. Introduction**

and treat it more effectively and safely.

illegal use of narcotic drugs.

tomy, cesarean section, amputation, etc. [4].

Introductory Chapter:

Understanding Postoperative Pain

*Victor M. Whizar-Lugo, Guillermo Domínguez-Cherit,* 

*Marissa Minutti-Palacios and Analucía Domínguez-Franco*

Postoperative pain (POP) is the result of the aggression of the surgical scalpel and sometimes of some anesthetic procedures. Both factors trigger a number of side effects including inflammation and nerve injury as a result of different pathophysiological mechanisms. This symptom can be devastating and does not have a useful biological function, which is why it is mandatory to prevent it, diagnose it, and treat it with a multimodal approach and thus reduce or avoid its multiple deleterious effects and, of course, reduce or evade the possibility of chronic postoperative pain (CPOP) [1, 2]. Despite advances in the comprehensive management of POP, its incidence could reach 86% of people who undergo surgery and suffer from moderate or severe POP on the first postoperative day [3]. Fortunately, physicians are now more interested in the proper management of POP and we have multiple resources to prevent

There are recognized factors for developing POP, such as age, pain prior to surgery,

general anesthesia, long-term surgery, and some types of surgery, such as mastec-

Proper management of POP includes drugs, anesthesia techniques, enhanced recovery pathways in surgery and anesthesia, as well as non-pharmacological modalities. At present, multimodal analgesia combines all these management modalities and it has been shown that the postoperative evolution is better and with a clear decrease in the consumption of opioids [5], which is essential in this critical period of legal and

The crisis of using illegal fentanyl mixed with other narcotics is a factor that should interest us in relation to a more rational management of opioids in the perioperative period. Although fentanyl and morphine have a prominent place in the management of POP, patients taking opioids prior to surgery have been found to be at high risk of continuing this habit even after they have recovered from their

The objective of this introductory chapter to our book on topics in postsurgical pain is the understanding of POP, its management, and repercussions on the evolu-

Anesthesia Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de México, México
