<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1409-0015</journal-id>
<journal-title><![CDATA[Medicina Legal de Costa Rica]]></journal-title>
<abbrev-journal-title><![CDATA[Med. leg. Costa Rica]]></abbrev-journal-title>
<issn>1409-0015</issn>
<publisher>
<publisher-name><![CDATA[Asociación Costarricense de Medicina Forense]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1409-00152017000100254</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Dolor postoperatorio: factores de riesgo y abordaje]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Quinde Cobos]]></surname>
<given-names><![CDATA[Paola]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,paola.quinco@gmail.com  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>03</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>03</month>
<year>2017</year>
</pub-date>
<volume>34</volume>
<numero>1</numero>
<fpage>254</fpage>
<lpage>264</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_arttext&amp;pid=S1409-00152017000100254&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_abstract&amp;pid=S1409-00152017000100254&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_pdf&amp;pid=S1409-00152017000100254&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen El dolor es una experiencia universal pero única para cada individuo. El proceso patológico que culmina en una intervención quirúrgica es una de las principales fuentes de dolor, muchas veces abordado y manejado de manera subóptima o en entornos que carecen de la organización adecuada. La utilización de la historia clínica y examen físico para la identificación de factores de riesgo conocidos para dolor postoperatorio agudo y crónico son fundamentales al elaborar un plan de manejo del dolor efectivo. Según las recomendaciones, se obtiene una mejor respuesta con el uso de terapia multimodal farmacológica y no farmacológica que involucra celecoxib preoperatorio, anestesia regional periférica o neuraxial, manejo de dolor postoperatorio con antiinflamatorios no esteroideos (AINES), acetaminofén, gabapentina o pregabalina; implementación de terapia cognitiva y de comportamiento. Monitoreo y valoración periódica del paciente para evaluar su respuesta a analgésicos y efectos adversos asociado a coordinación y planeamiento eficaz de protocolos y guías en cada centro de salud, se han visto de utilidad al valorar a un grupo tan heterogéneo e impredecible.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract: Pain is a universal experience but unique for every individual. The pathological processes that end in a surgical intervention are some of the main pain sources, often approached and managed suboptimally or without proper organization. The use of clinical history and physical examination to identify known risk factors to postoperative acute and chronic pain are fundamental to elaborate an effective pain management plan. According to recommendations, the outcome improves with pharmacological and non-pharmacological multimodal analgesia, including celecoxib before surgery, peripheral regional anesthesia or neuraxial techniques, management of postoperative pain with nonsteroidal anti-inflammatory drugs, acetaminophen, gabapentin or pregabalin; implementation of cognitive - behavioral therapy. Monitoring and periodic assessments associated with coordination and planning of protocols and guidelines in every clinical center, have been useful to evaluate a heterogeneous and unpredictable group, in order to establish the patients&#8217; response to analgesics and their adverse effects.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Manejo de dolor postoperatorio]]></kwd>
<kwd lng="es"><![CDATA[dolor postoperatorio]]></kwd>
<kwd lng="es"><![CDATA[dolor postoperatorio agudo]]></kwd>
<kwd lng="es"><![CDATA[analgesia]]></kwd>
<kwd lng="es"><![CDATA[terapia multimodal]]></kwd>
<kwd lng="es"><![CDATA[dolor neuropático]]></kwd>
<kwd lng="es"><![CDATA[percepción del dolor]]></kwd>
<kwd lng="en"><![CDATA[Postoperative pain management]]></kwd>
<kwd lng="en"><![CDATA[acute postoperative pain]]></kwd>
<kwd lng="en"><![CDATA[chronic postoperative pain]]></kwd>
<kwd lng="en"><![CDATA[analgesia]]></kwd>
<kwd lng="en"><![CDATA[multimodal therapy]]></kwd>
<kwd lng="en"><![CDATA[neuropathic pain]]></kwd>
<kwd lng="en"><![CDATA[pain perception]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Radnovich]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Chapman]]></surname>
<given-names><![CDATA[CR]]></given-names>
</name>
<name>
<surname><![CDATA[Gudin]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Panchal]]></surname>
<given-names><![CDATA[SJ]]></given-names>
</name>
<name>
<surname><![CDATA[Webster]]></surname>
<given-names><![CDATA[LR]]></given-names>
</name>
<name>
<surname><![CDATA[Pergolizzi Jr]]></surname>
<given-names><![CDATA[JV]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Acute pain: effective management requires comprehensive assessment]]></article-title>
<source><![CDATA[Postgrad Med]]></source>
<year>2014</year>
<volume>126</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>59-72</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Carroll]]></surname>
<given-names><![CDATA[IR]]></given-names>
</name>
<name>
<surname><![CDATA[Hah]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Barelka]]></surname>
<given-names><![CDATA[PL]]></given-names>
</name>
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[CK]]></given-names>
</name>
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[BM]]></given-names>
</name>
<name>
<surname><![CDATA[Gillespie]]></surname>
<given-names><![CDATA[MJ]]></given-names>
</name>
<name>
<surname><![CDATA[McCue]]></surname>
</name>
<name>
<surname><![CDATA[Younger]]></surname>
<given-names><![CDATA[JW]]></given-names>
</name>
<name>
<surname><![CDATA[Trafton]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Humphreys]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Goodman]]></surname>
<given-names><![CDATA[SB]]></given-names>
</name>
<name>
<surname><![CDATA[Dirbas]]></surname>
<given-names><![CDATA[FM]]></given-names>
</name>
<name>
<surname><![CDATA[Mackey]]></surname>
<given-names><![CDATA[SC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Pain Duration and Resolution following Surgery: An Inception Cohort Study]]></article-title>
<source><![CDATA[Pain Med]]></source>
<year>2015</year>
<volume>16</volume>
<page-range>2386-96</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="book">
<collab>Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education</collab>
<source><![CDATA[Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research]]></source>
<year>2011</year>
<publisher-loc><![CDATA[Washington (DC) ]]></publisher-loc>
<publisher-name><![CDATA[National Academies Press (US)]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Humble]]></surname>
<given-names><![CDATA[SR]]></given-names>
</name>
<name>
<surname><![CDATA[Dalton]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
<name>
<surname><![CDATA[Li]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A systematic review of therapeutic interventions to reduce acute and chronic post-surgical pain after amputation, thoracotomy or mastectomy]]></article-title>
<source><![CDATA[Eur J Pain]]></source>
<year>2015</year>
<volume>19</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>451-65</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rawal]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Current issues in postoperative pain management]]></article-title>
<source><![CDATA[Eur J Anaesthesiol]]></source>
<year>2016</year>
<volume>33</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>160-71</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Correll]]></surname>
<given-names><![CDATA[DJ]]></given-names>
</name>
<name>
<surname><![CDATA[Vlassakov]]></surname>
<given-names><![CDATA[KV]]></given-names>
</name>
<name>
<surname><![CDATA[Kissin]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[No evidence of real progress in treatment of acute pain, 1993-2012: scientometric analysis]]></article-title>
<source><![CDATA[J Pain Res]]></source>
<year>2014</year>
<volume>11</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>199-210</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sjövall]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Laparoscopic Surgery: A Narrative Review of Pharmacotherapy in Pain Management]]></article-title>
<source><![CDATA[Drugs]]></source>
<year>2015</year>
<volume>75</volume>
<numero>16</numero>
<issue>16</issue>
<page-range>1867-89</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ghoneim]]></surname>
</name>
<name>
<surname><![CDATA[O´Hara]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[O&#8217;Hara]]></surname>
<given-names><![CDATA[MW]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Depression and postoperative complications: an overview]]></article-title>
<source><![CDATA[BMC Surg]]></source>
<year>2016</year>
<volume>2</volume>
<numero>16</numero>
<issue>16</issue>
<page-range>5</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gerbershagen]]></surname>
<given-names><![CDATA[HJ]]></given-names>
</name>
<name>
<surname><![CDATA[Aduckathil]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[van Wijck]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
<name>
<surname><![CDATA[Peelen]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
<name>
<surname><![CDATA[Kalkman]]></surname>
<given-names><![CDATA[CJ]]></given-names>
</name>
<name>
<surname><![CDATA[Meissner]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures]]></article-title>
<source><![CDATA[Anesthesiology]]></source>
<year>2013</year>
<volume>118</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>934-44</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kalso]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Persistent postsurgery pain: research agenda for mechanisms, prevention, and treatment]]></article-title>
<source><![CDATA[Br J Anaesth]]></source>
<year>2013</year>
<volume>111</volume>
<page-range>9-12</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<collab>Werner &amp; Kongsgaard</collab>
<article-title xml:lang=""><![CDATA[Defining persistent postsurgical pain: is an update required?]]></article-title>
<source><![CDATA[Br J Anaesth]]></source>
<year>2014</year>
<volume>113</volume>
<page-range>1-4</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Haroutiunian]]></surname>
</name>
<name>
<surname><![CDATA[Nikolajsen]]></surname>
</name>
<name>
<surname><![CDATA[Finnerup]]></surname>
<given-names><![CDATA[NB]]></given-names>
</name>
<name>
<surname><![CDATA[Jensen]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The neuropathic component in persistent postsurgical pain. A systematic literature review]]></article-title>
<source><![CDATA[Pain]]></source>
<year>2013</year>
<volume>154</volume>
<page-range>95-102</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Boogaard]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Predictors of Persistent Neuropathic Pain--A Systematic Review]]></article-title>
<source><![CDATA[Pain Physician]]></source>
<year>2015</year>
<volume>18</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>433-57</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chou]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Gordon]]></surname>
<given-names><![CDATA[DB]]></given-names>
</name>
<name>
<surname><![CDATA[de Leon-Casasola]]></surname>
<given-names><![CDATA[OA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiolo-gists&#8217; Committee on Regional Anesthesia, Executive Committee, and Administrative Council]]></article-title>
<source><![CDATA[J Pain]]></source>
<year>2016</year>
<volume>17</volume>
<page-range>131-57</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cooper]]></surname>
<given-names><![CDATA[SA]]></given-names>
</name>
<name>
<surname><![CDATA[Desjardins]]></surname>
<given-names><![CDATA[PJ]]></given-names>
</name>
<name>
<surname><![CDATA[Turk]]></surname>
<given-names><![CDATA[DC]]></given-names>
</name>
<name>
<surname><![CDATA[Dworkin]]></surname>
<given-names><![CDATA[RH]]></given-names>
</name>
<name>
<surname><![CDATA[Katz]]></surname>
<given-names><![CDATA[NP]]></given-names>
</name>
<name>
<surname><![CDATA[Kehlet]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Ballantyne]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Burke]]></surname>
<given-names><![CDATA[LB]]></given-names>
</name>
<name>
<surname><![CDATA[Carragee]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Cowan]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Croll]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Dionne]]></surname>
<given-names><![CDATA[RA]]></given-names>
</name>
<name>
<surname><![CDATA[Farrar]]></surname>
<given-names><![CDATA[JT]]></given-names>
</name>
<name>
<surname><![CDATA[Gilron]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Gordon]]></surname>
<given-names><![CDATA[DB]]></given-names>
</name>
<name>
<surname><![CDATA[Iyengar]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Jay]]></surname>
<given-names><![CDATA[GW]]></given-names>
</name>
<name>
<surname><![CDATA[Kalso]]></surname>
<given-names><![CDATA[EA]]></given-names>
</name>
<name>
<surname><![CDATA[Kerns]]></surname>
<given-names><![CDATA[RD]]></given-names>
</name>
<name>
<surname><![CDATA[McDermott]]></surname>
<given-names><![CDATA[MP]]></given-names>
</name>
<name>
<surname><![CDATA[Raja]]></surname>
<given-names><![CDATA[SN]]></given-names>
</name>
<name>
<surname><![CDATA[Rappaport]]></surname>
<given-names><![CDATA[BA]]></given-names>
</name>
<name>
<surname><![CDATA[Rauschkolb]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Royal]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Segerdahl]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Stauffer]]></surname>
<given-names><![CDATA[JW]]></given-names>
</name>
<name>
<surname><![CDATA[Todd]]></surname>
<given-names><![CDATA[KH]]></given-names>
</name>
<name>
<surname><![CDATA[Vanhove]]></surname>
<given-names><![CDATA[GF]]></given-names>
</name>
<name>
<surname><![CDATA[Wallace]]></surname>
<given-names><![CDATA[MS]]></given-names>
</name>
<name>
<surname><![CDATA[West]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[White]]></surname>
<given-names><![CDATA[RE]]></given-names>
</name>
<name>
<surname><![CDATA[Wu]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Research design considerations for single-dose analgesic clinical trials in acute pain: IMMPACT recommendations]]></article-title>
<source><![CDATA[Pain]]></source>
<year>2016</year>
<volume>157</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>288-301</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Shea]]></surname>
<given-names><![CDATA[RA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Pain intensity and postoperative pulmonary complications among the elderly after abdominal surgery]]></article-title>
<source><![CDATA[Heart Lung]]></source>
<year>2002</year>
<volume>31</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>440-9</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
