Advances in postoperative pain management: the pharmacy perspective

The pharmacist's role in promoting proper use of analgesic drug therapies, by ensuring that Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards for pain management are met, evaluating new analgesic options for formulary addition, and conducting medication-use evaluations, outcomes research, and pharmacoeconomic analyses, is discussed. Pharmacists can be instrumental in meeting JCAHO requirements for educating clinical staff and patients about pain management practices and monitoring compliance with JCAHO pain management standards. They also can thoroughly evaluate new analgesic drug therapies and delivery systems for formulary addition by reviewing published literature and manufacturers' data and conducting medication-use evaluations, outcomes research, and pharmacoeconomic analyses. Cost-effectiveness analysis is the most common among the four types of pharmacoeconomic analyses, which include cost-minimization analysis, cost-benefit analysis, and cost-utility analysis. A ten-step process is used in conducting pharmacoeconomic analyses to increase the validity of the results. Implementation of new analgesic drug delivery technologies, such as an elastomeric infusion pump (a device for continuous wound infiltration with a local anesthetic), a needle-free transdermal patient-controlled analgesia system, and a new sustained-release, liposome-encapsulated form of morphine for epidural injection, offers new postoperative pain management alternatives for patients and clinical staff and involves unique considerations for pharmacists.