Contemporary Approaches to Postoperative Pain Management | Journal CME Article-Contemporary Approaches to Postoperative Pain Management Article

Contemporary Approaches to Postoperative Pain Management Article

Pdf Summary

The article from the American Society of Plastic Surgeons focuses on contemporary approaches to postoperative pain management, emphasizing the use of multimodal, opioid-sparing analgesia. Inadequate management of postoperative pain is linked to worsened outcomes and a higher risk of chronic postsurgical pain. Despite the long-established efficacy of multimodal approaches, their adoption as a standard of care has increased only recently due to the opioid epidemic. Enhanced Recovery After Surgery (ERAS) pathways now include multimodal analgesia as a key component, proving effective at reducing opioid use and associated side effects, speeding recovery, improving outcomes, and lowering costs.<br /><br />The paper outlines optimal postoperative pain management strategies, including the importance of understanding pain pathophysiology and considering patient-specific factors. The ERAS approach, initially used in colorectal surgery, integrates evidence-based practices across the perioperative period, offering enhanced recovery and better surgical outcomes. In plastic surgery, these protocols—developed for procedures like microsurgical and breast reconstruction—significantly reduce opioid consumption and hospital stays.<br /><br />Preoperative expectation management is crucial for pain control, with identified predictors for increased postoperative pain including preoperative anxiety or depression, type of surgery, and patient demographics. Educating patients on realistic pain outcomes and engaging them in shared decision-making leads to better results. Non-opioid analgesics, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), are recommended for scheduled use post-surgery due to their proven efficacy in reducing pain and opioid consumption. Injectable and regional anesthesia, like Exparel (liposomal bupivacaine), are discussed, though evidence for the latter's superiority is mixed.<br /><br />The article concludes by advocating for a tailored multimodal analgesia strategy combining patient education, preoperative medications, intraoperative local anesthesia, and scheduled post-op non-opioid regimens to effectively manage pain without routine reliance on opioids.

Keywords

postoperative pain management

multimodal analgesia

opioid-sparing

ERAS pathways

pain pathophysiology

plastic surgery

non-opioid analgesics

patient education

regional anesthesia

chronic postsurgical pain