الفهرس 
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Abstract
English summary Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Throughout the world, chronic pain is the most frequent cause of suffering and disability that seriously impair the quality of life. Studies have shown that a wide variety of cancer operations to be associated with chronic pain syndromes. Pain modulating mechanisms operate at different levels in the pain pathway including peripheral sensitization of nociceptors, central sensitization at the level of the spinal cord and the action of the dorsal horn cells as a gate for control of pain transmission. Lastly, these pain modulating mechanisms are controlled by the brain inhibitory (analegesia) system. Unrelieved pain after surgery increase heart rate, systemic vascular resistance and circulating catecholamines placing patient at risk of myocardial ischemia, stroke, bleeding and other complications such as reduced mobility and consequent loss of strength, disturbed sleep, immune impairment, increased susceptibility to disease and dependence on medication. Also, unrelieved acute pain commonly elicits pathophysiologic neural alterations that evolve into chronic pain syndromes. Thus effective treatment of chronic pain improves the overall quality of life.
Assessing pain requires measurement tools that are valid and reliable, as well as an ability to communicate. Cancer surgery operations done to repair or remove part of the body to diagnose or treat cancer which remains the foundation of cancer treatment. The anesthesiologists and acute pain management team responsible for the patient’s analgesic therapy can play an important role in improving the patient’s surgical outcomes by the use of one or more of the following therapeutic modalities either locally or systematic (opioid and non opioid ) or both (multimodal analgesia). However strong opioids analgesics as Morphine, Hydromorphone, Pethidine and Fentanyl still represent the most valuable and powerful analgesics for the management of moderate to severe post operative pain which can be applied by different routs including intravenous, transdermal, sublingual, inhalationl, intranasal (IN), and oral.
Multimodal analgesia Multimodal (or balanced) analgesia represents an increasingly popular approach to prevent postoperative pain and facilitating the recovery process as recovery from surgical procedures can be limited by postoperative pain because it produces discomfort and interrupts sleep, contributing to postoperative fatigue so inadequate postoperative
analgesia after pelvi-abdominal oncology surgical procedures may delay or prevent patient discharge and can result in readmission. Clear evidence based guidelines for the management of chronic pain after surgery should be available where guidelines are probably the best approach. The treatment should be directed at whatever mechanism is thought to be responsible for that pain. The patient’s description of the pain is of great importance and the most important aspect of management is to listen to the patient’s story, perform a thorough examination and then gives a full and frank explanation of the problem. chronic pain rehabilitation programs provide an opportunity for chronic pain patients to take a completely different approach to their pain problem. The benefits of chronic pain treatment are reflected by a patient’s return to a more normal, less pain focused life, rather than by an improvement in pain level