Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines

Abstract

Background Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. Material and methods An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. Conclusion Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies.

Factors Associated With New Analgesic Requirements Following Critical Illness

“…This is at odds to prior data, which has previously stated that patients with elective admissions report lower pain levels and draw fewer analgesic prescriptions than elective admissions due to well-established and honed enhanced recovery after surgery (ERAS) pathways. 26 , 27 The reason for this is unclear, but it may be explained by the fact that the matching process included total hospital length of stay, and therefore identified patients with more complex elective procedures requiring both longer hospital stays and increased analgesic requirements. The only other association identified during this study was that male patients were at reduced odds of requiring stronger analgesic prescriptions following hospital discharge.…”

Enhanced perioperative care in emergency general surgery: the WSES position paper

“…Indeed, avoiding opioids has been demonstrated to facilitate mobilization and to fasten GI function recovery [ 65 ]. The treatment of pain should be multimodal and tailored to patients’ conditions, according to available skills [ 106 ].…”

Expert Consensus on Ion Channel Drugs for Chronic Pain Treatment in China

“… 43 The therapeutic status of calcium ion channel drugs (gabapentin and pregabalin) in chronic postoperative or posttraumatic pain has been clarified in the multiple clinical practice guidelines and expert consensus. 48–50 …”