[Postoperative pain therapy in orthopedics]

Area of Science:

• Anesthesiology
• Pharmacology
• Pain Management

Background:

• Postoperative pain management is crucial for patient recovery and comfort.
• The World Health Organization (WHO) provides a three-step analgesic ladder for pain control.
• Current practices involve a combination of non-opioid and opioid analgesics.

Purpose of the Study:

• To outline the principles of effective postoperative pain management.
• To emphasize the WHO's three-step analgesic ladder recommendations.
• To guide clinicians in selecting appropriate pain management strategies.

Main Methods:

• Adherence to the WHO three-step analgesic ladder: Step I (non-opioid), Step II (low-potency opioid), Step III (high-potency opioid).
• Prioritization of non-opioid administration before opioids.
• Preference for intravenous (IV) administration in the immediate postoperative period, transitioning to oral medication as early as feasible.
• Emphasis on slow-release oral formulations for opioid therapy.
• Limited role for intramuscular (IM) drug administration.
• Integration of regional anesthesia (pre- or intraoperative) to minimize systemic medication requirements.

Main Results:

• The WHO ladder guides the combination of non-opioids and opioids (low or high potency).
• Non-opioids are typically administered before opioids.
• Transition from IV to oral pain medication is preferred early post-surgery.
• Slow-release oral opioids are recommended for sustained pain relief.
• Regional anesthesia complements systemic analgesia, reducing overall medication needs.
• Increased or persistent pain may indicate postsurgical complications.

Conclusions:

• Physicians should select a limited range of pain medications to master their effects and side effects.
• Effective postoperative pain management involves a stepwise approach, considering route of administration and drug formulation.
• Monitoring for complications is essential when pain management requirements change postoperatively.