Advances in the Management of Acute Postsurgical Pain: A Review

Abstract

Despite the millions of surgeries performed every year around the world, postoperative pain remains prevalent and is often addressed with inadequate or suboptimal treatments. Chronic postsurgical pain is surprisingly prevalent, and its rate varies with the type of surgery, as well as with certain patient characteristics. Thus, better clinical training is needed as well as patient education. As pain can be caused by more than one mechanism, multimodal or balanced postsurgical analgesia is appropriate. Pharmacological agents such as opioid and nonopioid pain relievers, as well as adjuvants and nonpharmacologic approaches, can be combined to provide better and opioid-sparing pain relief. Many specialty societies have guidelines for postoperative pain management that emphasize multimodal postoperative analgesia. These guidelines are particularly helpful when dealing with special populations such as pregnant patients or infants and children. Pediatric pain control, in particular, can be challenging as patients may be unable to communicate their pain levels. A variety of validated assessment tools are available for diagnosis. Related to therapy, most guidelines agree on the fact that codeine should be used with extreme caution in pediatric patients as some may be “rapid metabolizers” and its use may be life-threatening. Prehabilitation is a preoperative approach that prepares patients in advance of elective surgery with conditioning exercises and other interventions to optimize their health. Prehabilitation may have aerobic, strength-training, nutritional, and counseling components. Logistical considerations and degree of patient adherence represent barriers to effective prehabilitation programs. Notwithstanding all this, acute postoperative pain represents a clinical challenge that has not yet been well addressed.

Current Approaches to Four Challenging Pain Syndromes

“…While investigators have examined postsurgical pain following specific types of surgical procedures, such as post-thoracotomy pain [3], there remains a paucity of highquality research on the overall subject and mechanisms behind enduring pain in the aftermath of surgical intervention. There is no universally accepted expert definition of CPSP, although an early and often used definition describes CPSP as pain, emerging after a surgical procedure and that has persisted for ≥2 months when all other causes can be excluded [3]. Later sources maintain that CPSP must have lasted at least three months [4].…”

The Efficacy of the Combination of Continuous Femoral Nerve Block and Intravenous Parecoxib on Rehabilitation in Patients Undergoing Total Knee Arthroplasty: A Double-Blind, Randomized Clinical Trial

“…Nonetheless, it requires an effective postoperative analgesia plan, as TKA is considered one of the most painful procedures in orthopedic surgery [3][4][5]. As much as 50% of TKA patients report severe pain after surgery, leading to prolongation of the rehabilitation period, reduced cooperation during physiotherapy sessions, and increased risk of chronic postsurgical pain development [6][7][8][9][10]. The aforementioned aspects contribute to longer hospital stays, higher costs, and an adverse socioeconomic impact [11,12].…”

The efficacy of peri-operative duloxetine on reducing post-operative pain and opioid doses – literature review

“…However, the most common problem occurring after inpatient and outpatient procedures continues to be postoperative pain [1,2]. Despite progress in understanding pain mechanisms and advances in new pain management strategies, post-operative pain remains a prevalent issue frequently addressed with inadequate treatments [2,3].…”