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New Advances in Acute Postoperative Pain Management

  • Other Pain (A Kaye and N Vadivelu, Section Editors)
  • Published:
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Abstract

Purpose of Review

Postoperative pain remains one of the most common challenges following inpatient and outpatient surgeries. With our advances in modern medicine, pain following surgical procedures still remains a challenge, though significant accomplishments have been made over the past few decades. This article highlights some of the promising new advances and approaches in postoperative pain management.

Recent Findings

Over the last decade, Enhanced Recovery after Surgery (ERAS) pathways and protocols are becoming the benchmark standards for enhancing postoperative recovery. Multimodal analgesia (MMA) is an essential component of such care. Further, in the wake of serious and persistent concern on the opioid epidemic in the USA, there has been a recent renewal of interest in non-opioid alternatives or adjuncts in controlling postoperative pain, often in the context of MMA. Intravenous (IV) acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), magnesium, ketamine, dexmedetomidine, liposomal bupivacaine, and newer neuraxial and peripheral regional techniques as well as patient-controlled modalities are gaining importance. Gabapentinoids have become popular but recent meta-analytic reviews have cast doubt on their routine use in perioperative settings. Among opioids, sublingual sufentanil, IV oxycodone, and iontophoretic transdermal fentanyl hold promise. Acupuncture and transcutaneous electrical nerve stimulation may be useful as adjuncts in MMA packages. Genetic testing, derivatives of herbal preparations, and an extended role of acute pain services may emerge as potential areas of importance in the future. There are, however, critical gaps in good quality evidence in many of the practice guideline recommendations.

Summary

In the era of opioid epidemic, several lines of evidence have emerged to support non-opioid-based drugs and approaches along with a few newer opioid formulations for postoperative pain management, although more research is needed to find the right balance of efficacy and safety.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance.

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Authors and Affiliations

  1. Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India

    Sukanya Mitra

  2. Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA

    Daniel Carlyle & Nalini Vadivelu

  3. California Northstate University College of Medicine, Elk Grove, CA, USA

    Gopal Kodumudi

  4. University of Connecticut School of Medicine, Farmington, CT, USA

    Vijay Kodumudi

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  1. Sukanya Mitra
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Correspondence to Sukanya Mitra.

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Sukanya Mitra, Daniel Carlyle, Gopal Kodumudi, Vijay Kodumudi, and Nalini Vadivelu declare no conflict of interest.

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Mitra, S., Carlyle, D., Kodumudi, G. et al. New Advances in Acute Postoperative Pain Management. Curr Pain Headache Rep 22, 35 (2018). https://doi.org/10.1007/s11916-018-0690-8

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