Postoperative pain management can involve a variety of medications, including both opioids and non-opioids.
Opioids
- Oral opioids: Oral opioids are recommended for postoperative pain management by the APS/ASA/ASRA 2016 guidelines
- Strong opioids: Strong opioids, such as morphine or oxycodone, are recommended for severe postoperative pain or if weaker analgesics are not sufficient, as per the SFAR 2019 guidelines
- IV patient-controlled analgesia: The AAST/GAIS/SIAARTI/WSES 2022 guidelines suggest IV patient-controlled analgesia over spinal patient-controlled analgesia for infusion of opioids, if indicated, in postoperative pain management whenever the IV route is viable
Non-opioids
- NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended as part of multimodal analgesia for postoperative pain management by the APS/ASA/ASRA 2016 guidelines . The AAST/GAIS/SIAARTI/WSES 2022 guidelines also suggest administering acetaminophen and NSAIDs in multimodal analgesia, if not contraindicated
- Gabapentinoids: Gabapentin or pregabalin are recommended as a component of multimodal analgesia by the APS/ASA/ASRA 2016 guidelines
- IV lidocaine: The SFAR 2019 guidelines recommend administering IV lidocaine infusion to decrease the level of postoperative pain and improve recovery in adult patients undergoing major surgery not benefiting from regional analgesia
- IV ketamine: The APS/ASA/ASRA 2016 guidelines suggest administering IV ketamine as a component of multimodal analgesia in adult patients with postoperative pain
- IV corticosteroids: The SFAR 2019 guidelines suggest administering IV dexamethasone 8 mg to reduce postoperative pain in adult patients
A variety of medications, both opioids and non-opioids, can be used for postoperative pain management. The choice of medication should be individualized based on the patient's specific circumstances, the severity of the pain, and the potential for adverse effects.