Much of this issue of Update is devoted to the important, although sometimes neglected, subject of postoperative pain relief. There has been a welcome upsurge of interest in this aspect of patient care in recent years during which time great advances have been made. These include the introduction of patient controlled analgesia, continuous epidural infusions and the concept of acute pain services managed by fully trained staff.

Such innovations are however expensive, not only in the purchase and maintenance of equipment such as infusion pumps, but also in the need for increased staff vigilance to ensure safety. Additional funds are unlikely to be available in developing countries, many of which are currently finding it difficult to provide even the most basic of anaesthesia services.

However, by focusing attention on this subject it is hoped that a greater understanding and increased awareness of patient's needs can result in improved patient comfort and safety in the postoperative period without the need for expensive innovations.

This review demonstrates how significant improvements are possible at minimal cost, for example the wider use of local anaesthetic solutions for wound infiltration or regional blockade and the regular assessment of patients in the post-operative period leading to the prompt administration of adequate analgesia.

The review provides valuable information on the range of therapies currently available and their appropriate use, not only in healthy adults but also in a wide variety of situations, such as the extremes of age and patients with concurrent medical conditions, where extra precautions are needed.

In many parts of the world the care of the patient in the post-operative period is felt to be the province of the surgeon. However, the conscientious anaesthetist has much to contribute to the well being of patients during this critical time. It is hoped that all clinicians, whatever their circumstances, will find something of value in this time review.

The two logos at the top of this editorial mark the beginning of a new era of co-operation between the World Federation of Societies of Anaesthesiologists and the International Association for the Study of Pain (IASP). Both bodies are keen to improve the management of pain, either acute or chronic, throughout the world. World Anaesthesia will publish regular articles on the management of pain drawn from IASP resources. The subject of these articles is up to you. Let us know what aspects of pain management would interest you most and we will respond.

Dr Iain Wilson
Dr Roger Eltringham
Ed Charlton

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