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Postoperative pain

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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Guidelines

1.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.
E
Use the APAIS tool to measure anxiety and/or the need for information during the preoperative period.
E
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  • Pain assessment

2.Medical management

General principles, initiation of treatment: identify and treat postoperative pain as soon as possible and as best as possible in all patients.
B
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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

3.Nonpharmacologic interventions

Cognitive-behavioral therapy: consider offering cognitive-behavioral modalities as part of a multimodal approach in adult patients.
C

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  • Alternative and complementary therapies

4.Therapeutic procedures

Local and regional anesthesia: as per WSES 2022 guidelines, administer regional anesthesia in both adult and pediatric patients in site-specific surgeries.
A
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5.Patient education

General counseling: as per WSES 2022 guidelines, provide adequate education to patients and their families about the surgical and anesthesiologic treatment, options, plans, and aims of pain management, whenever possible.
B

6.Preventative measures

Preemptive analgesia: as per WSES 2022 guidelines, consider administering preemptive analgesia to reduce postoperative opioid consumption.
C

7.Quality improvement

Hospital policies: ensure that facilities performing surgery have an organizational structure in place to develop and refine policies and processes for safe and effective delivery of postoperative pain control.
B
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