Evidence-Based Strategies for Multimodal Postoperative Pain Management

Abstract

Surgery causes postoperative pain that should be immediately and effectively treated. Postoperative pain management is in central focus when planning postoperative treatment and is becoming the standard of care after surgical protocols -Enhanced Recovery after Surgery (ERAS). There are various serious complications associated with poorly controlled postoperative pain in adult surgical patients -cardiopulmonary complications, unplanned hospital admission, prolonged hospital stays, development of chronic pain, opioid side effects, opioid hyperalgesia and addiction. Studies have identified activation and sensitization of peripheral nociceptors and spinal dorsal horn neurons after surgical incision, and their specific mechanisms have been investigated. Basic scientific data and many clinical investigations suggest that different pain states result depending on the type and location of the incision, and that additional surgical procedures cause pain states of various severities in other sites. Supported by basic science, these observations have led to the development of the concept of procedure-specific postoperative pain management. The main value and novelty of procedure-specific postoperative pain management guidelines are that the guidelines are evidence-based, consider relevant patient characteristics, the role of anesthetic and surgical techniques, the balance between the invasiveness of the analgesic technique and the intensity of postoperative pain, as well as balance between analgesic efficacy and adverse event profile of the analgesic medications and procedures. In this review, the authors discuss the preventive and multimodal strategies of acute pain therapy, the pharmacotherapy of multimodal analgesia and local and regional techniques for specific surgical procedures.