Acute Pain Management: A Practical Guide.

Abstract

Virginia Mason Medical Center, Department of Anesthesiology, Seattle, Washington. anessl@vmmc.orgAcute Pain Management: A Practical Guide. By Pamela E. Macintyre, L. Brian Ready. Harcourt Health Sciences, 2001. Pages: 258. Cost: $36.00.“Location, location, location” is the common advice when shopping for housing and “audience, audience, audience” could be considered the corollary when shopping for a textbook. The authors of Acute Pain Management rightly state in their preface that their target audience is nurses, medical students, and junior residents. This audience will find the book useful and full of information, whereas senior residents, fellows, and pain medicine physicians may be disappointed.The introduction does a succinct job of discussing rationale for treatment of acute pain and measurements of pain, although a brief summary of evidence for beneficial effects of acute pain management on costs and outcomes would have been welcome. The chapters on pharmacology of opioids and local anesthetics do a nice job of summarizing analgesic effects, side effects, and treatment of side effects. Chapters on delivery of opioids, including patient controlled analgesia, are well written and provide very nice examples of order forms and protocols used by the authors’ institutions. The chapter on epidural analgesia is a bit weaker. Epidural opioids and continuous epidural infusions are well covered. However, the section on trouble shooting epidural analgesia fails to discuss common clinical management strategies such as changing ratios of local anesthetic to opioid to address component specific side effects (e.g. , decreasing amount of opioid to reduce risk of pruritus) or use of “multi-modal” analgesia to treat inadequate analgesia (e.g. , nonsteroidal anti-inflammatory drugs, PRN intravenous opioids). More recently investigated agents such as clonidine and epinephrine and more recent delivery techniques such as patient controlled epidural analgesia are barely mentioned, as are spinal opioids. Again, nice examples of continuous epidural infusion order forms from the authors’ institution are provided. The sections on other techniques and agents for acute pain management are quite superficial and do not begin to cover continuous peripheral nerve techniques, transcutaneous electrical stimulation, acupuncture, or nonsteroidal anti-inflammatory drugs. The section on the opioid-dependent patient will be very important for the designed audience but primarily covers systemic opioids. Epidural analgesia in this population is barely addressed. The section on acute neuropathic pain could probably be eliminated, as this area begins to crossover into chronic pain, and the space would be better devoted to the previously mentioned bare spots. Overall, this will be a helpful guide for the tar-get audience in addressing management of conventional delivery (systemic, continuous epidural infusion) of conventional agents (opioids and local anesthetics) for acute pain. This guide would also be useful for the pain medicine practitioner looking to start an acute pain service and needing to in-service staff and design order forms and protocols.FIGURE