Korean J Anesthesiol.  2018 Oct;71(5):345-352. 10.4097/kja.d.18.00217.

Designing the ideal perioperative pain management plan starts with multimodal analgesia

Affiliations
  • 1Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
  • 2Department of Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA. emariano@stanford.edu
  • 3Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.

Abstract

Multimodal analgesia is defined as the use of more than one pharmacological class of analgesic medication targeting different receptors along the pain pathway with the goal of improving analgesia while reducing individual class-related side effects. Evidence today supports the routine use of multimodal analgesia in the perioperative period to eliminate the over-reliance on opioids for pain control and to reduce opioid-related adverse events. A multimodal analgesic protocol should be surgery-specific, functioning more like a checklist than a recipe, with options to tailor to the individual patient. Elements of this protocol may include opioids, non-opioid systemic analgesics like acetaminophen, non-steroidal anti-inflammatory drugs, gabapentinoids, ketamine, and local anesthetics administered by infiltration, regional block, or the intravenous route. While implementation of multimodal analgesic protocols perioperatively is recommended as an intervention to decrease the prevalence of long-term opioid use following surgery, the concurrent crisis of drug shortages presents an additional challenge. Anesthesiologists and acute pain medicine specialists will need to advocate locally and nationally to ensure a steady supply of analgesic medications and in-class alternatives for their patients' perioperative pain management.

Keyword

Acute pain management; Ketamine; Multimodal analgesia; Non-opioid analgesics; Opioid epidemic; Regional anesthesia

MeSH Terms

Acetaminophen
Acute Pain
Analgesia*
Analgesics
Analgesics, Opioid
Anesthesia, Conduction
Anesthetics, Local
Checklist
Humans
Ketamine
Pain Management*
Perioperative Period
Prevalence
Specialization
Acetaminophen
Analgesics
Analgesics, Opioid
Anesthetics, Local
Ketamine
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