Management of Perioperative Pain

Principles of Pain Assessment

The American Society of Anesthesiologists recommends that patient self-assessment is the most valuable tool for measuring pain, using validated scales such as NRS, VAS, or VRS 4
For non-communicative patients, observational scales like BPS or CPOT should be applied, although they are less reliable than patient-reported metrics 5, 4
The American College of Surgeons suggests that functional assessment should guide the provision of opioid analgesia, not solely unidimensional pain scores 2, 6
A CPOT score >2 has a sensitivity of 86% and specificity of 78% for predicting significant pain in postoperative adults 5

The World Health Organization recommends administering acetaminophen at the start of postoperative analgesia, as it is safer and more effective than other drugs 1, 3
Preemptive therapy with acetaminophen (1g before laparotomy) reduces opioid side effects, hospital stay, and costs 1, 3
The American Academy of Pain Medicine suggests that AINEs are more effective than opioids for surgical dental pain and kidney stones 7
Coxibs should be considered if there are no contraindications 1
Preemptive and preventive administration of AINEs reduces pain and morphine use 3

The American Society of Regional Anesthesia and Pain Medicine recommends epidural anesthesia/analgesia for postoperative analgesia in patients undergoing abdominal aortic surgery 5
The combination of multimodal systemic analgesia with regional analgesia is recommended 4
Infiltration of the surgical site with local anesthetic is a key component of multimodal analgesia 8, 9

The American Pain Society recommends that periodic evaluation of pain scores is mandatory using validated systems to assess response to treatments and allow adjustments 10, 4
Monitoring 24 hours/day with regular evaluation and documentation ensures better pain treatment 3
After a pain intervention, the patient should be reevaluated for both pain control and adverse reactions at an appropriate interval 3

The American Society of Anesthesiologists suggests that patients with chronic opioid use should be considered for opioid tapering before surgery if feasible 2
The dose of opioids should be adjusted by age (not weight) and consider renal function 2
Patients tolerant to opioids may require additional interventions in the post-anesthesia care unit to facilitate optimal pain management 2

The Centers for Disease Control and Prevention recommends using a patient-centered approach to limit the number of pills and duration of opioid prescriptions at discharge, typically to less than one week 6
Automatic post-discharge opioid prescription refills should be avoided; patient review should be performed if more opioids are requested 6
The oral route should be used as soon as possible for medication administration 2