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      Acute postoperative pain management

      Author(s): 1 , 2
      Publication date Created:
      Publication date (Electronic):
      Journal: British Journal of Surgery
      Publisher: Wiley

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          Abstract

          Background

          Acute postoperative pain is common. Nearly 20 per cent of patients experience severe pain in the first 24 h after surgery, a figure that has remained largely unchanged in the past 30 years. This review aims to present key considerations for postoperative pain management.

          Methods

          A narrative review of postoperative pain strategies was undertaken. Searches of the Cochrane Library, PubMed and Google Scholar databases were performed using the terms postoperative care, psychological factor, pain management, acute pain service, analgesia, acute pain and pain assessment.

          Results

          Information on service provision, preoperative planning, pain assessment, and pharmacological and non-pharmacological strategies relevant to acute postoperative pain management in adults is presented, with a focus on enhanced recovery after surgery pathways.

          Conclusion

          Adequate perioperative pain management is integral to patient care and outcomes. Each of the biological, psychological and social dimensions of the pain experience should be considered and understood in order to provide optimum pain management in the postoperative setting.

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          Most cited references111

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          Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

          Nathaniel E. Brummel, Waleed Alhazzani, Ken Kiedrowski … (2018)
          To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU.
          Article 0 comments Cited 747 times – based on 0 reviews     Review now
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            Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council.

            Roger Chou, Debra B Gordon, Oscar A de Leon-Casasola … (2016)
            Most patients who undergo surgical procedures experience acute postoperative pain, but evidence suggests that less than half report adequate postoperative pain relief. Many preoperative, intraoperative, and postoperative interventions and management strategies are available for reducing and managing postoperative pain. The American Pain Society, with input from the American Society of Anesthesiologists, commissioned an interdisciplinary expert panel to develop a clinical practice guideline to promote evidence-based, effective, and safer postoperative pain management in children and adults. The guideline was subsequently approved by the American Society for Regional Anesthesia. As part of the guideline development process, a systematic review was commissioned on various aspects related to various interventions and management strategies for postoperative pain. After a review of the evidence, the expert panel formulated recommendations that addressed various aspects of postoperative pain management, including preoperative education, perioperative pain management planning, use of different pharmacological and nonpharmacological modalities, organizational policies, and transition to outpatient care. The recommendations are based on the underlying premise that optimal management begins in the preoperative period with an assessment of the patient and development of a plan of care tailored to the individual and the surgical procedure involved. The panel found that evidence supports the use of multimodal regimens in many situations, although the exact components of effective multimodal care will vary depending on the patient, setting, and surgical procedure. Although these guidelines are based on a systematic review of the evidence on management of postoperative pain, the panel identified numerous research gaps. Of 32 recommendations, 4 were assessed as being supported by high-quality evidence, and 11 (in the areas of patient education and perioperative planning, patient assessment, organizational structures and policies, and transitioning to outpatient care) were made on the basis of low-quality evidence.
            Article 0 comments Cited 411 times – based on 0 reviews     Review now
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              Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018

              U O Gustafsson, M Scott, M Hübner … (2018)
              This is the fourth updated Enhanced Recovery After Surgery (ERAS®) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded recommendations for each ERAS item within the ERAS® protocol.
              Article 0 comments Cited 398 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: British Journal of Surgery
                Publisher: Wiley
                ISSN (Print): 0007-1323
                ISSN (Electronic): 1365-2168
                Publication date Created: January 2020
                Publication date Created: January 05 2020
                Publication date Created: January 05 2020
                Publication date Other: January 2020
                Publication date (Print): January 05 2020
                Publication date (Electronic): January 05 2020
                Volume: 107
                Issue: 2
                Pages: e70-e80
                Affiliations
                [1 ]Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
                [2 ]Department of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
                Article
                DOI: 10.1002/bjs.11477
                PubMed ID: 31903595
                SO-VID: 302e7549-afca-44aa-b0bf-52f7b852916f
                Copyright © © 2020
                License:

                https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model

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