From the Department of Anesthesiology, New England Medical Center, Boston, Mass.
Powerful scientific, social, and economic forces are changing the practice
of medicine and surgery. Surgical trauma, particularly during major procedures
that involve extensive incisions and resection, has short-term and long-term
consequences. Such sequelae, evident even with the most skillful surgical
technique, include pain, immobility, pulmonary dysfunction,1
hypercoagulability, and stress hormone secretion to produce tissue breakdown
or water retention.2 These undesired responses
to tissue injury not only impair postoperative quality of life but also impede
rehabilitation, increase the likelihood of complications, and raise the direct
and indirect costs of care. Therefore, a convergence of motives has emerged
among patients and families who wish to minimize perioperative pain and suffering,
surgeons and anesthesiologists who desire an uncomplicated and speedy convalescence,
and administrators who seek to minimize the costs of care.3
This convergence has yielded impressive progress in minimally invasive surgical
techniques. Cholecystectomy, for example, is now performed more frequently
through a laparoscopic approach than an open incision,4
and each month surgeons witness the "closing" of yet another previously "open"
procedure (eg, herniorrhaphy, colectomy, thoracotomy, coronary artery bypass
Carr DB. Preempting the Memory of Pain. JAMA. 1998;279(14):1114–1115. doi:10.1001/jama.279.14.1114
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