TY - JOUR
T1 - Rational Multimodal Analgesia for Perioperative Pain Management
AU - Joshi, Girish P.
N1 - Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2023/8
Y1 - 2023/8
N2 - Purpose of Review: A multimodal analgesic approach improves postoperative pain relief and reduces opioid use; however, it is not universally implemented. This review presents the evidence assessing multimodal analgesic regimens and recommends optimal analgesic combinations. Recent Findings: The evidence for best combinations of individual patients undergoing specific procedures is lacking. Nevertheless, an optimal multimodal regimen may be determined based on identifying efficacious, safe, and inexpensive analgesics interventions. Summary: Key components of an optimal multimodal analgesic regimen include the preoperative identification of patients at high risk for postoperative pain in addition to patient and caregiver education. Unless contraindicated, all patients should receive a combination of acetaminophen, non-steroidal anti-inflammatory drug or cycoxygenase-2-specific inhibitor, dexamethasone, and procedure-specific regional analgesic technique and/or surgical site local anesthetic infiltration. Opioids should be administered as rescue adjuncts. Non-pharmacological interventions are important components of an optimal multimodal analgesic technique. It is imperative to integrate multimodal analgesia regimens within a multidisciplinary enhanced recovery pathway.
AB - Purpose of Review: A multimodal analgesic approach improves postoperative pain relief and reduces opioid use; however, it is not universally implemented. This review presents the evidence assessing multimodal analgesic regimens and recommends optimal analgesic combinations. Recent Findings: The evidence for best combinations of individual patients undergoing specific procedures is lacking. Nevertheless, an optimal multimodal regimen may be determined based on identifying efficacious, safe, and inexpensive analgesics interventions. Summary: Key components of an optimal multimodal analgesic regimen include the preoperative identification of patients at high risk for postoperative pain in addition to patient and caregiver education. Unless contraindicated, all patients should receive a combination of acetaminophen, non-steroidal anti-inflammatory drug or cycoxygenase-2-specific inhibitor, dexamethasone, and procedure-specific regional analgesic technique and/or surgical site local anesthetic infiltration. Opioids should be administered as rescue adjuncts. Non-pharmacological interventions are important components of an optimal multimodal analgesic technique. It is imperative to integrate multimodal analgesia regimens within a multidisciplinary enhanced recovery pathway.
KW - Analgesics
KW - Evidence-based medicine
KW - Multimodal analgesia
KW - Opioid-related adverse events
KW - Opioids
KW - Perioperative pain
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U2 - 10.1007/s11916-023-01137-y
DO - 10.1007/s11916-023-01137-y
M3 - Review article
C2 - 37405552
AN - SCOPUS:85163941063
SN - 1531-3433
VL - 27
SP - 227
EP - 237
JO - Current pain and headache reports
JF - Current pain and headache reports
IS - 8
ER -