Post-operative analgesia

High-risk patients undergo simple operations as well as complicated ones. Optimal analgesia for simple procedures can be deduced from systematic reviews. For simple drug treatments we know that oral non-steroidal anti-inflammatory drugs (NSAIDs) are the most effective and that injected opioids need to be given at higher doses to beat the oral NSAIDs. For patients who cannot take NSAIDs combinations of paracetamol and opioid are the next best choice. For high-risk surgery spinals and epidurals using combinations of local anaesthetic and opioid may enable radical change in hospital stay and morbidity from the procedure. Against this must be set any risk from the spinal or epidural itself.