Feature Article

A multimodal approach to managing postoperative pain

Stephan Schug

Figures

© svyatoslav lypynsky/stock.adobe.com
© svyatoslav lypynsky/stock.adobe.com

Abstract

Postoperative pain is the most common acute pain state. Management should be based on a multimodal approach, using a combination of analgesic drugs and techniques that have different modes or sites of action. This has the potential to improve recovery and reduce postoperative complications. 

 

Key Points

  • Postoperative pain is the most common acute pain condition. It requires management for humane reasons, but also because management will improve recovery, facilitate rehabilitation and reduce complications.
  • Postoperative pain should be controlled by multimodal analgesia – the combination of multiple analgesic medications and techniques to improve pain relief and reduce opioid requirements and, thereby, related complications.
  • Important components of multimodal analgesia are nonopioids (paracetamol and NSAIDs), adjuvants that reduce central sensitisation (e.g. gabapentinoids, alpha-2 agonists, N-methyl-D-aspartate receptor antagonists) and techniques of regional anaesthesia (peripheral and neuraxial approaches).
  • An underestimated complication of acute postoperative pain is the development of chronic postsurgical pain, which is often neuropathic and requires prevention and early treatment.
  • Care needs to be taken with regard to opioids prescribed to patients at discharge as these can result in long-term use, misuse and abuse. Limited prescribing and good communication between the specialist and the GP are important components of ‘opioid stewardship’.

Figures

© svyatoslav lypynsky/stock.adobe.com
© svyatoslav lypynsky/stock.adobe.com