New Practice Guidelines for Management of Postoperative Pain

HealthDay News – The American Pain Society has issued recommendations on the management of postoperative pain. The clinical practice guideline was published in the February issue of the Journal of Pain.

Roger Chou, MD, of the Oregon Health and Science University in Portland, and colleagues, with input from the American Society of Anesthesiologists, convened a multidisciplinary expert panel to develop a clinical practice guideline for evidence-based, effective, and safer management of postoperative pain in children and adults. The guideline also was reviewed and approved by the American Society for Regional Anesthesia.

The authors conducted a systematic review of the evidence and formulated 32 recommendations for 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. 

Notable recommendations include:

Recommendation 6: The panel recommends that clinicians offer multimodal analgesia, or the use of a variety of analgesic medications and techniques combined with nonpharmacological interventions, for the treatment of postoperative pain in children and adults 

Recommendations 7 and 8: The panel recommends that clinicians consider transcutaneous electrical nerve stimulation (TENS) as an adjunct to other postoperative pain treatments (weak recommendation, moderate-quality evidence). The panel can neither recommend nor discourage acupuncture, massage, or cold therapy as adjuncts to other postoperative pain treatments (insufficient evidence).

Recommendation 10: The panel recommends oral over intravenous (IV) administration of opioids for postoperative analgesia in patients who can use the oral route (strong recommendation, moderate quality evidence).

Recommendation 13: The panel recommends against routine basal infusion of opioids with IV PCA in opioid-naive adults (strong recommendation, moderate-quality evidence).

Recommendation 16: The panel recommends that clinicians consider giving a preoperative dose of oral celecoxib in adult patients without contraindications (strong recommendation, moderate-quality evidence).

Recommendation 17: The panel recommends that clinicians consider use of gabapentin or pregabalin as a component of multimodal analgesia (strong recommendation, moderate-quality evidence).

Recommendation 18 The panel recommends that clinicians consider IV ketamine as a component of multimodal analgesia in adults (weak recommendation, moderate quality evidence).

Summary and Clinical Applicability

Proper management of postoperative pain begins with an assessment of the patient in the preoperative period and development of a care plan specific to the individual and the surgical procedure involved. 

“Safe and effective postoperative pain management should be on the basis of a plan of care tailored to the individual and the surgical procedure involved, and multimodal regimens are recommended in many situations,” the authors write.

Reference

Chou R, Gordon DB, De leon-casasola OA, et al. 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. J Pain. 2016;17(2):131-57