Management of moderate pain after orthopaedic surgery: A multiregional expert consensus model for postoperative and...

Moderate post-operative pain after orthopaedic surgery remains highly prevalent and frequently persists beyond hospital discharge, negatively impacting mobilisation, rehabilitation, patient satisfaction and risk of chronic post-surgical pain. Despite established multimodal analgesic strategies, clinical pathways remain heterogeneous and insufficiently standardised. The objective was to develop a shared, reproducible, and implementable model for the management of moderate post-operative pain in orthopaedic surgery, both during hospitalisation and at discharge, to support institutional protocol development. An adapted virtual Nominal Group Technique (vNGT) was used as a structured consensus methodology. Three regional expert panels were convened in Campania, Lombardia and Emilia Romagna. Before each meeting, panellists completed a structured pre-meeting survey and received preparatory material. Each meeting followed pre-defined vNGT stages: introduction and framing of the consensus questions, individual idea generation, structured round-robin sharing, clarification and refinement of statements, completion of standardised decision tables and post-meeting review/acceptance of the synthesised framework. Survey responses and decision tables were analysed qualitatively and comparatively to identify convergent principles, setting-specific operational variables, and reproducible components. A reproducible model emerged based on systematic pain assessment, defined analgesic targets, multimodal analgesia centred on scheduled non-opioid therapy, integration of loco-regional techniques, rational, rescue based opioid use, structured continuity of care at discharge. Setting specific declinations were defined for: (1) Day surgery and Arthroscopy, (2) major trauma surgery in the elderly, (3) lower limb arthroplasty surgery and (4) discharge management across all settings. This vNGT-derived framework provides an implementable structure for institutional pain management protocols in orthopaedic surgery and represents a foundation for future outcome-based validation studies.

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