Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways

Area of Science:

• Anesthesiology
• Pain Management
• Surgical Recovery

Background:

• Postoperative pain significantly impedes recovery, prolonging hospital stays and delaying milestones.
• Opioid-based analgesia commonly used in the postoperative setting leads to adverse effects, complicating patient discharge.
• Multimodal analgesia, combining various pain management strategies, is central to Enhanced Recovery After Surgery (ERAS) protocols.

Purpose of the Study:

• To review analgesic techniques employed in multimodal regimens for optimal postoperative pain control.
• To summarize evidence on the efficacy of these techniques in reducing opioid consumption and side effects.

Main Methods:

• Review of pharmacological and non-pharmacological analgesic modalities.
• Inclusion of systemic agents (opioids, non-opioids), regional anesthesia, and neuraxial techniques.
• Consideration of adjunctive non-pharmacological methods like acupuncture and music therapy.

Main Results:

• Pharmacological options include acetaminophen, NSAIDs, NMDA antagonists, anticonvulsants, beta-blockers, alpha-2 agonists, capsaicin, and glucocorticoids.
• Central neuraxial techniques, surgical-site infiltration, and regional anesthesia are effective pharmacological adjuncts.
• Non-pharmacological techniques show mixed evidence but are generally safe.

Conclusions:

• Advancements in multimodal analgesia continue, yet postoperative pain remains inadequately managed.
• Conducting randomized trials to ascertain the specific contribution of each component in multimodal analgesia is challenging within ERAS research.