Postoperative analgesia and patient satisfaction.

Opioids continue to be the mainstay of postoperative pain control after surgery. "As required" (PRN) scheduling of intramuscular (or intravenous) opioid administration by health care attendants has been shown to be inadequate for postoperative analgesia. The shortcomings of traditional methods of opioid administration for postoperative analgesia have been reviewed by Oden. 1 Recent major improvements in postoperative pain control are related mostly to alternative methods of opioid administration, in particular the use of spinal opioids 2 or patientcontrolled administration (PCA) of opioids. 3 In general, these and other modalities of postoperative analgesia are best provided at an institution by a dedicated team of health care professionals comprising an Acute Pain Service.4 Anaesthetists have played a leading role in developing Acute Pain Services worldwide. s The best choice of anallgesic technique for each patient's postoperative requirements is not always clear now that we have an impressive array of effective modalities. These include different opioid administration techniques, e.g., spinal opioids, PCA (edidural, intravenous), intravenous infusions, ~s­ buccal, sublingual, rectal, nasal, etc.; local anesthetic agents (spinal, regional); non-steroidal anti-inflammatory agents (NSAIDS); alpha-adrenergic agents (systemic, spinal); and combinations of two or more of the above regimens.6 Collaborative research between anaesthesia and psychology may help to determine the particular method of postoperative analgesia best suited for a given patient. Recent studies have highlighted the relationship between specific emotional and psychological factors and satisfaction with iv-PCA.710 One of the more interesting implications of this work is that it may be possible to improve satisfaction and analgesic effectiveness by sele~tively matching specific patient characteristics with aspects of the postoperative analgesia delivery system. For example, the multidimensional health locus of control (MHLC) scale measures the extent to which individuals believe