Recommendations for the Management of Acute Perioperative Pain

The United States (US) Health and Human Services Pain Management Best Practices Inter-Agency Task Force along with 13 organizations collectively formulated 7 common guiding principles for the management of acute perioperative pain. These recommendations were published in Regional Anesthesia & Pain Management.

A national goal in the US is to decrease the prescription of opioid medications. This target has a disproportionate effect in the perioperative clinical care setting, in which it is important to prioritize multimodal and opioid-sparing approaches while maintaining optimal patient care.

All patients undergoing surgery should be evaluated by clinicians for medical and psychological conditions, history of chronic pain, substance use disorders, and previous and current medication regimens and response. Currently, a preoperative comprehensive review of pain history is not standard practice, but this information allows clinicians to better tailor the postoperative pain management strategy.

Postoperative pain should be evaluated by using validated pain assessment tools. Educating patients about pain scales early during care allows patients and clinicians to establish the most effective communication tools such that their pain is adequately managed. The Numeric Rating Scale (NRS) is simple but must be used on multiple occasions to provide comparator data. The Functional Pain Scale, Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference domain, and Defense and Veterans Pain Rating Scale (DVPRS) may be better choices for patients who have had difficulty with other validated instruments.

Postoperative pain should be treated with multimodal analgesia combined with nonpharmacological interventions. Clinicians should ensure they are not relying solely on opioids.

Clinicians should prioritize patient and caregiver education such that they are aware of what to expect and what the treatment regimen comprises. Patients and their caregivers should be well aware of realistic postoperative expectations related to their pain. Educational materials should be tailored to the patient’s level of education as well as their linguistic, cultural, and religious beliefs.

Education should also instruct patients and caregivers about proper storage, tapering methods, and disposal of excess medications. A survey found that ~75% of patients store opioids in unsecure locations and <30% plan to properly dispose of unused pills. Patients should understand why storage and disposal of opioid medications are important and necessary.

Patients should be monitored for pain management and adverse events, altering the treatment plan if evidence suggests inadequate care. Nonpharmacological and nonopioid medications should be escalated in a stepwise fashion on the basis of pain trajectories. The recommendation authors advised for clinicians to follow the analgesic ladder from the World Health Organization.

Clinicians should have access to pain specialists for consultations about patients who are experiencing inadequately controlled postoperative pain. Patients with higher levels of pain than expected are at elevated risk for persistent postsurgical pain and should receive a consultation with a pain specialist.

The management of postsurgical pain is complex, and clinicians should strive to keep up to date with all current recommendations to ensure patients are receiving the best evidence-based care they deserve.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Mariano ER, Dickerson DM, Szokol JW, et al. A multisociety organizational consensus process to define guiding principles for acute perioperative pain management. Reg Anesth Pain Med. 2021;rapm-2021-103083. doi:10.1136/rapm-2021-103083