The concept of "preemptive" analgesia (above) suggests that the best postoperative pain

management begins preoperatively. Some studies suggest that anesthetic techniques can also reduce

the neuroendocrine stress response to surgery and pain. Regional anesthetic techniques in which a

catheter can be left in place also provide an excellent means for postoperative analgesia. Intercostal

and epidural anesthesia can additionally improve respiratory function following thoracic and upper

abdominal operations and encourage early ambulation. Epidural and possibly spinal anesthesia reduce

the incidence of thromboembolism following hip surgery and attenuate the hypercoagulation state

following vascular procedures. Postoperative pain control is generally best managed by

anesthesiologists, because they offer regional anesthetic techniques as well as pharmacological

expertise in analgesics. Concerns over increased cost may be unjustified because some studies have

demonstrated lower mortality and morbidity, as well as reduced hospital costs, with these techniques.

Postoperative analgesic modalities include oral or parenteral analgesics, peripheral nerve blocks,

neuraxial blocks with local anesthetics, intraspinal opioids, as well as adjunctive techniques such as

TENS and physical therapy. Selection of analgesic techniques is generally based on three factors: the

patient, the procedure, and the setting (inpatient versus outpatient).