Management of Postoperative Pain
Publication Date: February 1, 2016
Recommendations
1 The panel recommends that clinicians provide patient and family-centered, individually tailored education to the patient (and/or responsible caregiver), including information on treatment options for management of postoperative pain, and document the plan and goals for postoperative pain management.
680
2 The panel recommends that the parents (or other adult caregivers) of children who undergo surgery receive instruction in developmentally-appropriate methods for assessing pain as well as counseling on appropriate administration of analgesics and modalities.
680
3 The panel recommends that clinicians conduct a preoperative evaluation including assessment of medical and psychiatric comorbidities, concomitant medications, history of chronic pain, substance abuse, and previous postoperative treatment regimens and responses, to guide the perioperative pain management plan.
680
4 The panel recommends that clinicians adjust the pain management plan on the basis of adequacy of pain relief and presence of adverse events.
680
5 The panel recommends that clinicians use a validated pain assessment tool to track responses to postoperative pain treatments and adjust treatment plans accordingly.
680
6 The panel recommends that clinicians offer multimodal analgesia, or the use of a variety of analgesic medications and techniques combined with nonpharmacological interventions, for the treatment of postoperative pain in children and adults.
680
7 The panel recommends that clinicians consider transcutaneous electrical nerve stimulation (TENS) as an adjunct to other postoperative pain treatments.
680
8 The panel can neither recommend nor discourage acupuncture, massage, or cold therapy as adjuncts to other postoperative pain treatments.
(insufficient evidence)
680
9 The panel recommends that clinicians consider the use of cognitive–behavioral modalities in adults as part of a multimodal approach.
680
10 The panel recommends oral over intravenous (i.v.) administration of opioids for postoperative analgesia in patients who can use the oral route.
680
11 The panel recommends that clinicians avoid using the intramuscular route for the administration of analgesics for management of postoperative pain.
680
12 The panel recommends that i.v. patient-controlled analgesia (PCA) be used for postoperative systemic analgesia when the parenteral route is needed.
680
13 The panel recommends against routine basal infusion of opioids with i.v. PCA in opioid-naive adults.
680
14 The panel recommends that clinicians provide appropriate monitoring of sedation, respiratory status, and other adverse events in patients who receive systemic opioids for postoperative analgesia.
680
15 The panel recommends that clinicians provide adults and children with acetaminophen and/or nonsteroidal anti-inflammatory drugs (NSAIDs) as part of multimodal analgesia for management of postoperative pain in patients without contraindications.
680
16 The panel recommends that clinicians consider giving a preoperative dose of oral celecoxib in adult patients without contraindications.
680
17 The panel recommends that clinicians consider use of gabapentin or pregabalin as a component of multimodal analgesia.
680
18 The panel recommends that clinicians consider i.v. ketamine as a component of multimodal analgesia in adults.
680
19 The panel recommends that clinicians consider i.v. lidocaine infusions in adults who undergo open and laparoscopic abdominal surgery who do not have contraindications.
680
20 The panel recommends that clinicians consider surgical site–specific local anesthetic infiltration for surgical procedures with evidence indicating efficacy.
680
21 The panel recommends that clinicians use topical local anesthetics in combination with nerve blocks before circumcision.
680
22 The panel does not recommend intrapleural analgesia with local anesthetics for pain control after thoracic surgery.
680
23 The panel recommends that clinicians consider surgical site–specific peripheral regional anesthetic techniques in adults and children for procedures with evidence indicating efficacy.
680
24 The panel recommends that clinicians use continuous, local anesthetic–based peripheral regional analgesic techniques when the need for analgesia is likely to exceed the duration of effect of a single injection.
680
25 The panel recommends that clinicians consider the addition of clonidine as an adjuvant for prolongation of analgesia with a single-injection peripheral neural blockade.
680
26 The panel recommends that clinicians offer neuraxial analgesia for major thoracic and abdominal procedures, particularly in patients at risk for cardiac complications, pulmonary complications, or prolonged ileus.
680
27 The panel recommends that clinicians avoid the neuraxial administration of magnesium, benzodiazepines, neostigmine, tramadol, and ketamine in the treatment of postoperative pain.
680
28 The panel recommends that clinicians provide appropriate monitoring of patients who have received neuraxial interventions for perioperative analgesia.
680
29 The panel recommends that facilities in which surgery is performed have an organizational structure in place to develop and refine policies and processes for safe and effective delivery of postoperative pain control.
680
30 The panel recommends that facilities in which surgery is performed provide clinicians with access to consultation with a pain specialist for patients with inadequately controlled postoperative pain or at high risk of inadequately controlled postoperative pain (eg, opioid-tolerant, history of substance abuse).
680
31 The panel recommends that facilities in which neuraxial analgesia and continuous peripheral blocks are performed have policies and procedures to support their safe delivery and trained individuals to manage these procedures.
680
32 The panel recommends that clinicians provide education to all patients (adult and children) and primary caregivers on the pain treatment plan including tapering of analgesics after hospital discharge.
680
Recommendation Grading
Disclaimer
Overview
Title
Management of Postoperative Pain
Authoring Organization
American Society of Regional Anesthesia and Pain Medicine
Publication Month/Year
February 1, 2016
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
Most patients who undergo surgical procedures experience acute postoperative pain, but evidence suggests that less than half report adequate postoperative pain relief. Many preoperative, intraoperative, and postoperative interventions and management strategies are available for reducing and managing postoperative pain.
Target Patient Population
Patients who undergo invasive procedure
Inclusion Criteria
Female, Male, Adolescent, Adult, Child, Older adult
Health Care Settings
Ambulatory, Hospital, Operating and recovery room, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management
Diseases/Conditions (MeSH)
D059408 - Pain Management, D059787 - Acute Pain, D013514 - Surgical Procedures, Operative, D010149 - Pain, Postoperative
Keywords
perioperative, Pain Management, acute pain
Source Citation
The Journal of Pain, Vol 17, No 2 (February), 2016: pp 131-157