Pain treatment and prophylaxis on pain.
Journal
Current opinion in anaesthesiology
ISSN: 1473-6500
Titre abrégé: Curr Opin Anaesthesiol
Pays: United States
ID NLM: 8813436
Informations de publication
Date de publication:
01 Dec 2022
01 Dec 2022
Historique:
pubmed:
27
9
2022
medline:
1
11
2022
entrez:
26
9
2022
Statut:
ppublish
Résumé
Also in ambulatory surgery, there will usually be a need for analgesic medication to deal with postoperative pain. Even so, a significant proportion of ambulatory surgery patients have unacceptable postoperative pain, and there is a need for better education in how to provide proper prophylaxis and treatment. Postoperative pain should be addressed both pre, intra- and postoperatively. The management should be with a multimodal nonopioid-based procedure specific guideline for the routine cases. In 10-20% of cases, there will be a need to adjust and supplement the basic guideline with extra analgesic measures. This may be because there are contraindications for a drug in the guideline, the procedure is more extensive than usual or the patient has extra risk factors for strong postoperative pain. Opioids should only be used when needed on top of multimodal nonopioid prophylaxis. Opioids should be with nondepot formulations, titrated to effect in the postoperative care unit and eventually continued only when needed for a few days at maximum. Multimodal analgesia should start pre or per-operatively and include paracetamol, nonsteroidal anti-inflammatory drug (NSAID), dexamethasone (or alternative glucocorticoid) and local anaesthetic wound infiltration, unless contraindicated in the individual case. Paracetamol and NSAID should be continued postoperatively, supplemented with opioid on top as needed. Extra analgesia may be considered when appropriate and needed. First-line options include nerve blocks or interfascial plane blocks and i.v. lidocaine infusion. In addition, gabapentinnoids, dexmedetomidine, ketamine infusion and clonidine may be used, but adverse effects of sedation, dizziness and hypotension must be carefully considered in the ambulatory setting.
Identifiants
pubmed: 36155493
doi: 10.1097/ACO.0000000000001190
pii: 00001503-202212000-00006
doi:
Substances chimiques
Acetaminophen
362O9ITL9D
Analgesics, Opioid
0
Analgesics
0
Analgesics, Non-Narcotic
0
Anti-Inflammatory Agents, Non-Steroidal
0
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
684-690Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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