The development of sedation and analgesia may be one of the preeminent advances in both medical science and human technology. The ability to alter human consciousness and perception of pain has opened the door to extraordinary possibilities for medical practice. However, the origins of these advances are ancient, likely reaching beyond the limits of written history. Ancient Greeks recognized that naturally occurring substances such as mandrake root and alcohol could alter consciousness and be used during surgical manipulations[1, 2]. Incan shamans used coca leaves to assist in trephination operations, in which burr holes drilled into the skull in an attempt to cure illnesses[1]. Surgeons in the Middle Ages used ice and so-called refrigeration anesthesia to dull pain sensation prior to incision [2, 3]. The development of procedural techniques and use of exogenous substances to alleviate suffering is one example of human ingenuity that is integral to our existence, and is ubiquitous across time and place.

A comprehensive pain management strategy is needed through the entire peri-procedure period for effective and safe patient care. Assessments and interventions pre-procedure, peri-procedure, and post-procedure are codependent. For example, failure to recognize an opioid-dependent patient during the initial pre-procedure screening may result in ineffective analgesia strategies. This chapter deals with important considerations with regard to pre-procedure, peri-procedure, and post-procedure patient assessment and pain management strategies. For a detailed discussion of patient evaluation and procedure selection, see Chapter 4.