Abstract
Postoperative pain is prevalent and often undertreated. There is a risk that untreated or suboptimally treated postoperative pain may transition into chronic postoperative pain, which can be challenging to treat. Clinical guidelines recommend the use of multimodal analgesia, including non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and, in some cases, opioids. NSAIDs are a broad class of drugs with different attributes such as cyclo-oxygenase (COX)-1 or COX-2 selectivity, onset of action, and analgesic potency. NSAIDs are associated with gastrointestinal and cardiovascular side effects and should be administered at the lowest effective dose for the shortest effective duration but can be effective in postoperative pain. The role of opioids in postoperative analgesia is long-standing but has recently come under scrutiny. Opioids are often used in multimodal analgesic combinations in such a way as to minimize the total consumption of opioids without sacrificing analgesic benefit. Special clinical considerations are required for surgical patients already on opioid regimens or with opioid use disorder. A particularly useful fixed-dose combination product for postoperative analgesia is dexketoprofen-tramadol, which confers safe and effective postoperative pain control and reduces the risk of persistent postoperative pain.
Highlights
BackgroundInadequately controlled postoperative pain continues to be a problem despite the fact that there is an armamentarium of pain relievers that can be deployed
Clinical guidelines recommend the use of multimodal analgesia, including non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and, in some cases, opioids
Opioids are often used in multimodal analgesic combinations in such a way as to minimize the total consumption of opioids without sacrificing analgesic benefit
Summary
Controlled postoperative pain continues to be a problem despite the fact that there is an armamentarium of pain relievers that can be deployed. A systematic review of 27 randomized controlled trials (n=1,494) found that patients treated with higher intraoperative doses of opioids had greater postoperative pain intensity, consumed more morphine at 24 hours after surgery, but showed no significant differences in the rates of nausea, vomiting, or drowsiness. Most of the studies used in this analysis involved remifentanil [43] Both opioid tolerance, a state of adaptation in which a drug loses its effect over time, and hyperalgesia, in which the patient has increased sensitivity to pain, may contribute to postoperative pain [44]. The exact multimodal regimen recommended for postoperative pain control depends on patient factors (age, comorbidities, frailty, drug therapies, substance use disorders, and so on), the type of surgery, and the setting (in hospital or outpatient) [5,47].
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