Acute Pain Management in the Perioperative Setting
Summary of Recommendations
Institutional Policies and Procedures for Providing Perioperative Pain Management
- Educational content should range from basic bedside pain assessment to sophisticated pain management techniques (e.g. , epidural analgesia, PCA, and various regional anesthesia techniques) and nonpharmacologic techniques (e.g. , relaxation, imagery, hypnotic methods).
- For optimal pain management, ongoing education and training are essential for new personnel, to maintain skills, and whenever therapeutic approaches are modified.
They should assist in evaluating patients who are experiencing problems with any aspect of perioperative pain relief.
They should participate in developing standardized institutional policies and procedures.
Preoperative Evaluation of the Patient
Preoperative Preparation of the Patient
Common misconceptions that overestimate the risk of adverse effects and addiction should be dispelled.
- Patient education for optimal use of PCA and other sophisticated methods, such as patient-controlled epidural analgesia, might include discussion of these analgesic methods at the time of the preanesthetic evaluation, brochures and videotapes to educate patients about therapeutic options, and discussion at the bedside during postoperative visits.
- Such education may also include instruction in behavioral modalities for control of pain and anxiety.
Perioperative Techniques for Pain Management
- These modalities should be used in preference to intramuscular opioids ordered “as needed.”
This capacity includes the ability to recognize and treat adverse effects that emerge after initiation of therapy.
Multimodal Techniques for Pain Management
Unless contraindicated, patients should receive an around-the-clock regimen of NSAIDs, COXIBs, or acetaminophen.
Regional blockade with local anesthetics should be considered.
- Aggressive and proactive pain management is necessary to overcome the historic undertreatment of pain in children.
- Perioperative care for children undergoing painful procedures or surgery requires developmentally appropriate pain assessment and therapy.
- Analgesic therapy should depend upon age, weight, and comorbidity, and unless contraindicated should involve a multimodal approach.
- Behavioral techniques, especially important in addressing the emotional component of pain, should be applied whenever feasible.
- Sedative, analgesic, and local anesthetics are all important components of appropriate analgesic regimens for painful procedures.
- Because many analgesic medications are synergistic with sedating agents, it is imperative that appropriate monitoring be used during the procedure and recovery.
- Pain assessment and therapy should be integrated into the perioperative care of geriatric patients.
- Pain assessment tools appropriate to a patient's cognitive abilities should be used. Extensive and proactive evaluation and questioning may be necessary to overcome barriers that hinder communication regarding unrelieved pain.
- Anesthesiologists should recognize that geriatric patients may respond differently than younger patients to pain and analgesic medications, often because of comorbidity.
- Vigilant dose titration is necessary to ensure adequate treatment while avoiding adverse effects such as somnolence in this vulnerable group, who are often taking other medications (including alternative and complementary agents).
- Anesthesiologists should recognize that patients who are critically ill, cognitively impaired, or have communication difficulties may require additional interventions to ensure optimal perioperative pain management.
- Anesthesiologists should consider a therapeutic trial of an analgesic in patients with increased blood pressure and heart rate or agitated behavior when causes other than pain have been excluded.
Acute Pain Management in the Perioperative Setting
February 1, 2012
External Publication Status
Country of Publication
Facilitate the safety and effectiveness of acute pain management in the perioperative setting; reduce the risk of adverse outcomes; maintain the patient's functional abilities, as well as physical and psychologic well-being; and enhance the quality of life for patients with acute pain during the perioperative period.
Female, Male, Adolescent, Adult, Child, Infant, Older adult
Health Care Settings
Emergency care, Hospital, Operating and recovery room
Nurse anesthetist, medical assistant, nurse, nurse practitioner, physician, physician assistant
Prevention, Management, Treatment
D059408 - Pain Management, D010149 - Pain, Postoperative, D011182 - Postoperative Care, D011300 - Preoperative Care
perioperative care, Pain Management, acute pain management, perioperative pain management
Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 2012;116(2):248-273. doi: https://doi.org/10.1097/ALN.0b013e31823c1030.