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Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics And Techniques: A Review

E. Wick, M. Grant, C. Wu
Published 2017 · Medicine

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Importance Amid the current opioid epidemic in the United States, the enhanced recovery after surgery pathway (ERAS) has emerged as one of the best strategies to improve the value and quality of surgical care and has been increasingly adopted for a broad range of complex surgical procedures. The goal of this article was to outline important components of opioid-sparing analgesic regimens. Observations Regional analgesia, acetaminophen, nonsteroidal anti-inflammatory agents, gabapentinoids, tramadol, lidocaine, and/or the N-methyl-D-aspartate class of glutamate receptor antagonists have been shown to be effective adjuncts to narcotic analgesia. Nonsteroidal anti-inflammatory agents are not associated with an increase in postoperative bleeding. A meta-analysis of 27 randomized clinical trials found no difference in postoperative bleeding between the groups taking ketorolac tromethamine (33 of 1304 patients [2.5%]) and the control groups (21 of 1010 [2.1%]) (odds ratio [OR], 1.1; 95% CI, 0.61-2.06; P = .72). After adoption of the multimodal analgesia approach for a colorectal ERAS pathway, most patients used less opioids while in the hospital and many did not need opioids after hospital discharge, although approximately 50% of patients received some opioid during their stay. Conclusions and Relevance 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.
This paper references
10.1213/ANE.0000000000000967
The Analgesic Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block in Adult Patients: A Meta-Analysis
M. Baeriswyl (2015)
10.1097/ALN.0b013e31818ec946
Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration
T. Horlocker (2009)
10.1213/ANE.0000000000000066
Transversus Abdominis Plane Block to Ameliorate Postoperative Pain Outcomes After Laparoscopic Surgery: A Meta-Analysis of Randomized Controlled Trials
G. D. De Oliveira (2014)
10.1001/JAMA.290.18.2455
Efficacy of postoperative epidural analgesia: a meta-analysis.
Brian M. Block (2003)
10.1111/j.1399-6576.2011.02463.x
A meta‐analysis of the efficacy of wound catheters for post‐operative pain management
A. Gupta (2011)
10.1093/bja/aen368
Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: meta-analysis of randomized trials.
N. Meylan (2009)
10.1007/s12630-014-0275-x
Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways
Mingjuan Tan (2014)
10.1016/j.amepre.2015.02.020
Trends in Opioid Analgesic-Prescribing Rates by Specialty, U.S., 2007-2012.
Benjamin A Levy (2015)
10.1213/01.ane.0000333274.63501.ff
A Systematic Review of Randomized Trials Evaluating Regional Techniques for Postthoracotomy Analgesia
G. Joshi (2008)
Thoracic epidural analgesia (TEA) vs. patient controlled analgesia (PCA) in laparoscopic colectomy: a meta-analysis. Hepatogastroenterology
H Liu (2014)
10.1001/JAMA.284.4.423B
JCAHO Pain Management Standards Are Unveiled
D. M. Phillips (2000)
10.1016/j.joms.2016.05.001
The Surgeon's Roles in Stemming the Prescription Opioid Abuse Epidemic.
J. Hupp (2016)
10.1097/00000542-200512000-00025
Does Multimodal Analgesia with Acetaminophen, Nonsteroidal Antiinflammatory Drugs, or Selective Cyclooxygenase-2 Inhibitors and Patient-controlled Analgesia Morphine Offer Advantages over Morphine Alone?: Meta-analyses of Randomized Trials
N. Elia (2005)
10.1056/NEJMp1011512
A flood of opioids, a rising tide of deaths.
S. Okie (2010)
10.1016/j.pain.2012.12.025
Intravenous acetaminophen reduces postoperative nausea and vomiting: A systematic review and meta-analysis
C. Apfel (2013)
10.1093/bja/aeu293
Impact of pregabalin on acute and persistent postoperative pain: a systematic review and meta-analysis.
B. M. Mishriky (2015)
10.1097/AAP.0b013e3181c15c70
Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition)
T. Horlocker (2009)
10.1097/DCR.0b013e318259bcd8
Perioperative Systemic Lidocaine for Postoperative Analgesia and Recovery after Abdominal Surgery: A Meta-analysis of Randomized Controlled Trials
Yanxia Sun (2012)
10.1097/PRS.0000000000001046
Ketorolac does not increase perioperative bleeding: a meta-analysis of randomized controlled trials.
J. Davidson (2015)
10.1097/ALN.0000000000000950
Perioperative Dextromethorphan as an Adjunct for Postoperative Pain: A Meta-analysis of Randomized Controlled Trials
M. King (2016)
10.1111/j.1399-6576.2005.00666.x
Effect of preoperative Cox‐II‐selective NSAIDs (coxibs) on postoperative outcomes: A systematic review of randomized studies
S. Straube (2005)
10.1097/ACO.0b013e32832f330a
Regional techniques and outcome: what is the evidence?
M. Hanna (2009)
10.1016/j.rapm.2006.01.005
The Analgesic Effects of Perioperative Gabapentin on Postoperative Pain: A Meta-Analysis
R. Hurley (2006)
10.1007/s00590-015-1722-2
Enhanced recovery programme reduces opiate consumption in hip hemiarthroplasty
R. Talboys (2015)
10.1001/jamasurg.2014.210
Analgesia after open abdominal surgery in the setting of enhanced recovery surgery: a systematic review and meta-analysis.
M. Hughes (2014)
10.1055/S-0031-1299812
Tramadol--the impact of its pharmacokinetic and pharmacodynamic properties on the clinical management of pain.
U. Klotz (2003)
10.1097/ALN.0b013e318297630d
Perioperative Systemic Magnesium to Minimize Postoperative Pain: A Meta-analysis of Randomized Controlled Trials
G. D. De Oliveira (2013)
10.1080/08897077.2012.735216
Topical Review on the Abuse and Misuse Potential of Tramadol and Tilidine in Germany
L. Radbruch (2013)
Thoracic epidural analgesia (TEA) vs. patient controlled analgesia (PCA) in laparoscopic colectomy: a meta-analysis.
Hongjin Liu (2014)
Tramadol, Pharmacology, Side Effects, and Serotonin Syndrome: A Review.
Burton D Beakley (2015)
10.1097/SLA.0000000000000237
Impact of Epidural Analgesia on Mortality and Morbidity After Surgery: Systematic Review and Meta-analysis of Randomized Controlled Trials
D. Pöpping (2014)
10.1097/00132586-199702000-00029
Parenteral ketorolac and risk of gastrointestinal and operative site bleeding. A postmarketing surveillance study.
B. Strom (1996)
10.1002/14651858.cd002765.pub2
Effects of nonsteroidal anti-inflammatory drugs on postoperative renal function in adults with normal renal function.
A. Lee (2004)
10.1002/14651858.CD006954.pub2
Local anaesthetic wound infiltration and abdominal nerves block during caesarean section for postoperative pain relief.
A. Bamigboye (2009)
10.1186/s12871-016-0223-0
Successful implementation of an Enhanced Recovery After Surgery program shortens length of stay and improves postoperative pain, and bowel and bladder function after colorectal surgery
Ankit Sarin (2015)
10.1002/14651858.CD004603.PUB3
Perioperative ketamine for acute postoperative pain.
R. Bell (2006)
10.1097/AOG.0000000000001833
Enhanced Recovery Pathways for Improving Outcomes After Minimally Invasive Gynecologic Oncology Surgery.
Dennis R Goulet (2017)
10.1185/03007995.2014.973484
Lidocaine patch for acute pain management: a meta-analysis of prospective controlled trials
Yaowu Bai (2015)
10.1001/ARCHSURG.142.5.417
Misinterpretation of the fifth vital sign.
R. Kozol (2007)
Opioid epidemic in the United States.
L. Manchikanti (2012)
10.1038/SJ.EBD.6400237
The Oxford Pain Group League table of analgesic efficacy
Derek Richards (2004)
10.1002/bjs.10087
Patient outcomes and provider perceptions following implementation of a standardized perioperative care pathway for open liver resection
A. Page (2016)



This paper is referenced by
10.1111/1759-7714.13343
Efficacy of transcutaneous electrical acupoint stimulation combined with general anesthesia for sedation and postoperative analgesia in minimally invasive lung cancer surgery: A randomized, double‐blind, placebo‐controlled trial
Jiheng Chen (2020)
10.21292/2078-5658-2019-16-6-54-59
Сравнительная оценка эффективности различных вариантов обезболивания после операции кесарева сечения
О. В. Рязанова (2020)
Multimodal Analgesia as Essential Component of ERAS Protocols
S. Mitra (2018)
10.1155/2020/8517652
Study on Main Drugs and Drug Combinations of Patient-Controlled Analgesia Based on Text Mining
Xing Jin (2020)
10.1001/jamasurg.2019.0574
Opioid Prescription After Surgery-Reply.
Ryan Michael Howard (2019)
10.1016/j.msec.2019.110608
Injectable in situ forming nanogel: A hybrid Alginate-NLC formulation extends bupivacaine anesthetic effect.
Gustavo H Rodrigues da Silva (2020)
10.1016/j.athoracsur.2020.01.042
What Drives Opioid Prescriptions following Cardiac Surgery: Practice or Patient?
Kimberly A. Holst (2020)
10.1016/J.PRATAN.2018.08.006
Analgésie multimodale, ce qu’il faut abandonner
Axel Maurice-Szamburski (2018)
10.1016/j.surg.2018.06.034
Opioid prescribing practices during implementation of an enhanced recovery program at a tertiary care hospital
Ashley W. Gerrish (2018)
COMPARATIVE ASSESSMENT OF EFFICACY OF VARIOUS ANESTHESIA OPTIONS AFTER CESAREAN SECTION
Ю. С. Александрович (2020)
10.1080/24740527.2020.1724775
Consensus Statement for the Prescription of Pain Medication at Discharge after Elective Adult Surgery
H. Clarke (2020)
10.1016/j.wneu.2019.05.101
Comparison of Effects of Hemostatic Gelatin Sponge Impregnated with Ropivacaine versus Normal Saline Applied on the Transverse Process of the Operated Vertebrae on Postoperative Pain in Patients Undergoing Spinal Instrumentation Surgery: A Randomized Clinical Trial.
Maroun Badwi Ghabach (2019)
10.1097/PSN.0000000000000201
Evaluating the Implementation of a Preemptive, Multimodal Analgesia Protocol in a Plastic Surgery Office
Brandi Tinsbloom (2017)
10.3171/2019.1.FOCUS18645
Opioid-free anesthesia within an enhanced recovery after surgery pathway for minimally invasive lumbar spine surgery: a retrospective matched cohort study.
E. Soffin (2019)
10.5811/westjem.2018.7.37989
Emergency Providers’ Pain Management in Patients Transferred to Intensive Care Unit for Urgent Surgical Interventions
Quincy K. Tran (2018)
10.1080/00325481.2019.1672374
Comparison of multimodal, sliding scale acute pain protocols with traditional prescribing in non-surgical patients
Jayne Pawasauskas (2019)
10.1001/jamasurg.2018.1039
Association of Opioid-Related Adverse Drug Events With Clinical and Cost Outcomes Among Surgical Patients in a Large Integrated Health Care Delivery System
S. Shafi (2018)
10.1097/BOT.0000000000001430
Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury
J. Hsu (2019)
10.5772/19959
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C. Negrila (2018)
10.1016/j.clnu.2019.10.023
Enhanced recovery programs in gastrointestinal surgery: Actions to promote optimal perioperative nutritional and metabolic care.
Luca Gianotti (2019)
10.1007/s11605-019-04167-3
Morpheus and the Underworld—Interventions to Reduce the Risks of Opioid Use After Surgery: ORADEs, Dependence, Cancer Progression, and Anastomotic Leakage
Robert Beaumont Wilson (2019)
10.3389/fphar.2019.00895
The Preclinical Pharmacological Study of a Novel Long-Acting Local Anesthetic, a Fixed-Dose Combination of QX-OH/Levobupivacaine, in Rats
Y. Zhang (2019)
10.1016/j.bja.2019.07.028
Dopaminergic neurotransmission and genetic variation in chronification of post-surgical pain.
R. R. V. van Reij (2019)
10.1016/J.BPA.2019.08.002
Pain measurement and critical review of analgesic trials: pain scores, functional pain measurements, limits and bias of clinical trials.
Adrien Lemoine (2019)
10.1111/EVE.12822
Multimodal analgesia, a fashionable term or evidence‐based medicine?
J.P.A.M. van Loon (2017)
10.2147/LRA.S181458
Non-Operating Room Anesthesia: Patient Selection and Special Considerations
Timothy Wong (2020)
10.1016/j.jpedsurg.2019.02.044
Decreased opioid prescribing in children using an enhanced recovery protocol.
Katherine J. Baxter (2019)
Analgesia multimodal en pacientes histerectomizadas por vía videolaparoscópica / Multimodal analgesia in patients laparoscopic hysterectomy
Yaime Soto Otero (2018)
10.7759/cureus.9646
Use of Erector Spinae Plane Block for Perioperative Pain Control in a Patient Undergoing Spinal Surgery
Ruben H Schwartz (2020)
10.1097/AAP.0000000000000691
Should Hospitals Market Opioid-Sparing Analgesia to Patients?
Alexander B. Stone (2017)
10.1111/papr.12689
Ultrasound‐Guided Intercostal Nerve Block Following Esophagectomy for Acute Postoperative Pain Relief in the Postanesthesia Care Unit
M. Zhu (2018)
10.1213/ANE.0000000000002537
Themed Issue on the Opioid Epidemic: What Have We Learned? Where Do We Go From Here?
H. Benzon (2017)
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