AIM: Over the last several years, significant efforts have been directed towards improving the quality of postoperative pain management. As data are lacking on the organization and quality of these services in Italy, we surveyed current Italian practices. METHODS: A 16-item questionnaire was randomly supplied to 650 anesthesiologists attending the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care Medicine (SIAARTI) National Congress in 2006. The survey requested information concerning their current practices in analgesic techniques, use of guidelines, educational programs, availability of an Acute Pain Service (APS), and existing barriers to optimal postoperative pain management. RESULTS: Based on 588 respondents, a sample of 163 hospitals was analyzed (24.4% of Italian public hospitals); 41.7% of the surveyed hospitals had an organized APS. University and teaching hospitals had an organized APS more frequently than did other hospitals (P<0.02). Continuous intravenous analgesia using elastomeric infusion systems was the most commonly used analgesic technique, performed in 44% of the treated patients. The frequency of both intravenous patient-controlled analgesia and epidural techniques was extremely low (5% and 13%, respectively). The main reasons given for suboptimal pain relief were inadequate training of surgeons and nurses (44.3%), poor organization (29.9%), and lack of equipment (21.5%). A total of 51.2% of the respondents would like to have a dedicated anesthesiologist assigned on a daily rotational basis to postoperative pain management. CONCLUSIONS: A comparison to international survey data showed that postoperative pain management in Italy is still below the European standards. Additional efforts to overcome these hurdles and to reach an acceptable level of quality are required.