Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques

Wick, Elizabeth C.; Grant, Michael C.; Wu, Christopher L.

doi:10.1001/jamasurg.2017.0898

Cited by 677 publications

(495 citation statements)

References 43 publications

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“…Regional analgesic techniques include neuraxial (eg, epidural, spinal), peripheral nerve blocks, and wound infiltration 135. Multimodal non-opioid analgesia use decreases post-operative nausea and vomiting and allows more rapid recovery 136 137…”

Section: Resultsmentioning

confidence: 99%

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Nelson¹,

Bakkum-Gamez

Kalogera

et al. 2019

Int J Gynecol Cancer

476

333

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BackgroundThis is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery.MethodsA database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.ResultsAll recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly.ConclusionsThe updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.

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Section: Resultsmentioning

confidence: 99%

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Nelson¹,

Bakkum-Gamez

Kalogera

et al. 2019

Int J Gynecol Cancer

476

333

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“…Multimodal analgesia is the most effective strategy to improve pain relief and reduce the side effects of every single agent (4,9,10). It is based on the use of a variety of analgesic agents and/or techniques that target different nociceptive mechanisms.…”

Section: Multimodal Analgesia Strategymentioning

confidence: 99%

“…Back in 2010, the Italian Society of Anesthesia, Analgesia and Intensive Care (SIAARTI) already recommended the adoption of multimodal analgesic strategies and underlined the importance of their adjustment to fast-track surgical settings (10). Recent reviews on analgesic care in ERAS protocols report the same concept, highlighting the necessity of combining systemic and loco-regional analgesia to favour opioidsparing strategies (4,5,11). The latter goal is extremely important, to minimize not only the side effects of this pharmacological class, but also the risk of respiratory complications of patients undergoing thoracic surgery.…”

Section: Multimodal Analgesia Strategymentioning

confidence: 99%

See 1 more Smart Citation

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Piccioni¹,

Segat²,

Falini³

et al. 2018

J. Thorac. Dis.

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Enhanced Recovery After Surgery (ERAS) is a multimodal, multidisciplinary approach to surgical patients with the aim of enhancing the quality of recovery after surgery (1,2). This strategy translates into faster post-operative recovery and improvements of outcomes. All the ERAS Society guidelines (freely available at www.erassociety.org) take into consideration the perioperative management of analgesia. The role of pain management in ERAS pathways is fundamental, considering the importance of containing surgical stress, reducing pain-related complications and speeding recovery (2-5). Correspondence to: Carlo Del Naja, MD. Casa Sollievo della Sofferenza Hospital, viale Cappuccini, 1, 71013 San Giovanni Rotondo (FG), Italy.Email: c.delnaja@operapadrepio.it.Abstract: Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that allows a faster recovery after thoracic surgery. Although enhanced recovery after surgery (ERAS) principles seem reasonably applicable to thoracic surgery, there is little literature on the application of such a strategy in this context. In regard to pain management, ERAS pathways promote the adoption of a multimodal strategy, tailored to the patients. This approach is based on combining systemic and loco-regional analgesia to favour opioid-sparing strategies. Thoracic paravertebral block is considered the first-line loco-regional technique for VATS. Other techniques include intercostal nerve block and serratus anterior plane block. Nonsteroidal anti-inflammatory drugs and paracetamol are essential part of the multimodal treatment of pain. Also, adjuvant drugs can be useful as opioid-sparing agents. Nevertheless, the treatment of postoperative pain must take into account opioid agents too, if necessary. All above is useful for careful planning and execution of a multimodal analgesic treatment to enhance the recovery of patients. This article summarizes the most recent evidences from literature and authors' experiences on perioperative multimodal analgesia principles for implementing an ERAS program after VATS lobectomy.

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“…The economic costs of the opioid crisis in terms of increased healthcare and substance abuse treatment costs, lost productivity, and criminal justice costs is estimated at nearly US$80 billion 3. Since the perioperative period may be a vulnerable period for the development of long-term and persistent opioid use, the use of regional anesthesia as part of a multimodal analgesic regimen4 may decrease perioperative opioid consumption while providing at least equivalent postoperative analgesia compared with an opioid-based regimen5 and, as a result, may potentially contribute to a decrease in opioid use after surgery.…”

Section: Introductionmentioning

confidence: 99%

Role of regional anesthesia and analgesia in the opioid epidemic

Lee

Kumar

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques

Abstract: Multimodal analgesia is readily available and the evidence is strong to support its efficacy. Surgeons should use this effective approach for patients both using and not using the ERAS pathway to reduce opioid consumption.

Cited by 677 publications

References 43 publications

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Role of regional anesthesia and analgesia in the opioid epidemic

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