Release Date: October 1, 2009
Expiration Date: October 31, 2010

NEEDS STATEMENT
Postoperative pain is a significant concern for patients undergoing inpatient or outpatient surgery. Despite the availability of a variety of pain medications and multiple means of providing analgesia—continuous epidural analgesia, single injection and continuous peripheral blocks, and intravenous (IV) patient-controlled analgesia (PCA)—evidence continues to point to suboptimal pain management in the postoperative setting. For the 45 million inpatient and 57 million outpatient medical procedures performed in the United States each year, physicians are challenged to provide safe and effective analgesia to patients in the perioperative setting.

Combining analgesics with different mechanisms of action aids the patient in the perioperative setting by targeting more than one pain pathway; this provides additional analgesia and perhaps synergistic pain-relieving effects. A multimodal approach to postoperative pain would provide effective analgesia, reduce opioid-related side effects, and improve clinical outcomes, such as length of hospital stay, morbidity, and mortality. However, the optimal combination of analgesics, dosages, and timing of administration to achieve these outcomes are not known. This monograph outlines the current parenteral treatment options and strategies available for the management of postoperative pain.

ACCREDITATION STATEMENT
Physician: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of AKH Inc. and Applied Clinical Education. AKH Inc. is accredited by the ACCME to provide continuing medical education for physicians. AKH Inc. designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Pharmacist: AKH Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. AKH Inc. approves this knowledge-based activity for 1.0 contact hour (0.1 CEU). UAN 077-999-09-048-H01-P.

LEARNING OBJECTIVES
At the completion of this activity, participants should be better prepared to:

1. Outline the advantages of multimodal analgesia for the surgical patient.
2. Describe the safety and adverse-event profiles of opioid and nonopioid analgesics in postoperative pain, and their implications for managing adverse effects.
3. Analyze recent evidence on emerging parenteral, nonopioid analgesics for the management of postoperative pain.

TARGET AUDIENCE
This activity is intended for anesthesiologists, surgeons, pharmacists, and other clinicians involved in postoperative pain management.

CONFLICT OF INTEREST STATEMENT
It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The faculty must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflict of interest is resolved by AKH Inc. prior to certification of the activity. AKH planners and reviewers have no relevant financial relationships to disclose.

DISCLOSURE OF UNLABELED USE
This educational activity contains discussion of published and/or investigational uses of nonsteroidal anti-inflammatory agents, opioids, acetaminophen, α₂-agonists, and NMDA receptor antagonists for the treatment of postoperative pain. Some uses of these agents have not been approved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

ESTIMATED TIME OF COMPLETION
This activity should take approximately 60 minutes to complete.

METHOD OF PARTICIPATION
There are no fees for participating in and receiving credit for this activity. The participant should, in order, read the objectives and monograph, answer the multiple-choice online post-test and complete the evaluation form. The evaluation form provides each participant with the opportunity to comment on the quality of the instructional process, the perception of enhanced professional effectiveness, the perception of commercial bias, and his/her views on future educational needs. A score of at least 70% is required to successfully complete this activity. One retake is allowed. Credit is available through October 31, 2010.

FACULTY
Eugene Viscusi, MD Chair
Associate Professor
Department of Anesthesiology
Director, Acute Pain Management Services
Jefferson Medical College
Thomas Jefferson University
Philadelphia, Pennsylvania

Keith Candiotti, MD
Associate Professor of Anesthesiology, and Internal Medicine
Vice Chairman for Clinical Research
Chief, Division of Perioperative Medicine
University of Miami
Miami, Florida

Raymond Sinatra, MD
Professor of Anesthesiology
Director, Yale University Pain Service
Yale-New Haven Hospital
New Haven, Connecticut

MEDICAL WRITER
Oren Traub, MD

FINANCIAL DISCLOSURE
Eugene Viscusi, MD: EKR Therapeutics, GlaxoSmithKline, and Wyeth (speakers' bureaus); Cadence Pharmaceuticals, Merck, and PriCara/Ortho-McNeil (advisory committees).

Keith Candiotti, MD: Cadence Pharmaceuticals, Johnson & Johnson, Merck, Pfizer, Inc., and Schering-Plough (speakers' bureaus); Cadence Pharmaceuticals and Johnson & Johnson (advisory committees).

Raymond Sinatra, MD: Endo Pharmaceuticals and Pricara/Ortho-McNeil (speakers' bureaus); Ortho-McNeil and Purdue Pharmaceuticals (advisory committees).

Oren Traub, MD: nothing to disclose.

DISCLAIMER
This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc., the author(s), and the publisher specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, undetected error, or reader's misunderstanding of the content.

SOFTWARE REQUIREMENTS
PC
Microsoft Windows 2000 SE or above.
Internet Explorer (v5.5 or greater), or Firefox
Adobe Acrobat Reader*

MAC
MAC OS 10.2.8
Safari
Adobe Acrobat Reader*
Internet Explorer is not supported on the Macintosh.

* Required to view printable (PDF) version of the lesson.

Jointly sponsored by AKH Inc. and Applied Clinical Education.

This activity is made possible by an educational grant from Cadence Pharmaceuticals.

Select a Profession to Continue: -- Other Physician Pharmacist

Copyright © AKH Inc. and Applied Clinical Education 2009.

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