Multimodality post proctologic surgery pain control

Abstract

A multimodal analgesia strategy is achievable and safe in patients undergoing proctologic surgery and it reduces the need for opioids use postoperatively. Pre-emptive preoperative analgesia prior to surgical incision yields better pain control compared to postoperative pain regimen alone. Recent evidence supports the use of multimodal analgesia perioperatively eliminating or reducing the need for postoperative opioids for pain control and thus reducing the undesirable narcotic-related side effects. Components of multimodal analgesia include opioids, non-steroidal anti-inflammatory drugs, acetaminophen (paracetamol), gabapentin, ketamine, dexamethasone, dexmedetomidine, and local anesthetics administered by infiltration, neuraxial, or pudendal nerve block. This approach decreases perioperative morbidity, accomplishes early hospital discharge, and enhances patient satisfaction without compromising on the safety and quality of care.