Table of contents
Postoperative pain
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of postoperative pain are prepared by our editorial team based on guidelines from the Global Alliance for Infection in Surgery (GAIS/WSES/AAST/SIAARTI 2022), the French Society of Anesthesia and Intensive Care (SFAR 2019), and the American Society of Anesthesiologists (ASA/APS/ASRA 2016).
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Diagnostic investigations
Preoperative assessment
As per SFAR 2019 guidelines:
Identify the most vulnerable patients to pain preoperatively (with risks to develop severe postoperative pain and/or chronic postoperative pain) by focusing on preoperative pain, including pain even far from the operating site, the long-term consumption of opioids, and surgical and psychological factors such as anxiety or depression.
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Use the APAIS tool to measure anxiety and/or the need for information during the preoperative period.
E
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Pain assessment
Medical management
General principles, initiation of treatment: as per AAST/GAIS/SIAARTI/WSES 2022 guidelines, identify and treat postoperative pain as soon as possible and as best as possible in all patients.
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General principles (adjustment of treatment)
Opioids
Non-opioids (NSAIDs)
Non-opioids (gabapentinoids)
Non-opioids (IV ketamine)
Non-opioids (IV lidocaine)
Non-opioids (IV corticosteroids)
Route of administration
Multimodal analgesia
Management of nausea and vomiting
Management of delirium
Management of respiratory distress
Palliative care
Nonpharmacologic interventions
Cognitive-behavioral therapy: as per APS/ASA/ASRA 2016 guidelines, consider offering cognitive-behavioral modalities as part of a multimodal approach in adult patients.
C
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Alternative and complementary therapies
Therapeutic procedures
Local and regional anesthesia: as per AAST/GAIS/SIAARTI/WSES 2022 guidelines, administer regional anesthesia in both adult and pediatric patients in site-specific surgeries.
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Transcutaneous electrical nerve stimulation