RESUMEN
Background: Proper postoperative pain management, which can be advanced using a multimodal approach, results in pain relief with minimal side effects. Newer recovery protocols, along with minimally invasive surgeries add to the better management of post-operative complication. Many factors play a role in failure of proper postoperative pain management, which mainly include insufficient education, fear of complications associated with analgesic drugs, poor pain assessment and inadequate staffing
Methodology: we conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE from January 1987 to March 2017. The following search terms were used: post-operative pain mechanism, post-operative pain management, non-opioid pain management
Aim of the work: In this study we aimed to understand the mechanism and the management of post-operative pain, along with shining some light upon the recent advances
Conclusion: Various combinations and modalities of pain management exist, and their use depends largely on the case, the patients, and their perception of pain. Enhanced recovery protocols have significantly improved perioperative and postoperative pain management, making the decrease in opioids need a priority
RESUMEN
The spleen is one of the most frequently injured intraperitoneal organs, and management of splenic injuries may require splenectomy. Traditionally, surgical removal of the spleen was done by an open approach using either an upper midline or left subcostal incision. Open splenectomy is performed in two major clinical scenarios: trauma and hematologic disease. With the advent of minimally invasive techniques, laparoscopic splenectomy has become a standard procedure for elective removal of the spleen for most indications. Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen. However, some contraindications still apply. The evolution of the technology has allowed though, cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches. Moreover, the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications. Today, laparoscopic splenectomy is considered safe, with better outcomes in comparison to open splenectomy, and the increased experience of surgeons allows operative times comparable to those of an open splenectomy. In this review we discussed the indications and the contraindications of laparoscopic splenectomy. Furthermore, we analyze the surgical techniques