Open Abdominal Aortic Aneurysm Repair

Abstract

This chapter describes the significant challenge that open repair of abdominal aortic aneurysms poses for acute pain medicine physicians. In particular, acute pain medicine physicians must have a solid understanding of ischemic pain mechanisms and temporizing analgesic strategies. Epidural analgesia is often optimal for postoperative pain control, but risks must be weighed in the setting of commonly used anticoagulants in this population. Patient-controlled opioid-based analgesia is an option; an advantage of its use is that the patient typically spends less time in pain and tends to use less medication than when medication is given according to a set schedule. However, it is characterized by numerous concerns related to safety and adverse events; if the PCA device is not programmed properly, it can result in the under- or overdosing of narcotics.