Fact or Fiction: Postoperative Pain Management

Medscape

04-06-2025

Effective postoperative pain management is crucial for enhancing patient recovery and reducing complications. Guidelines emphasize a multimodal approach, integrating pharmacologic and nonpharmacologic strategies to address the complex nature of postoperative pain. This includes using regional anesthesia techniques, non-opioid analgesics, and complementary therapies tailored to individual patient needs. Such comprehensive strategies aim to minimize opioid consumption and associated adverse effects, thereby promoting better outcomes.
Persistent opioid use is reported in up to 10% of opioid-naive patients more than 90 days after surgery. Among those discharged with opioid prescriptions, approximately 70% retain a supply at home — and of that, 90% is stored insecurely. A recent study published in JAMA found that spinal surgery, older age, longer hospital stay, history of substance use disorder, and previous opioid discontinuation before surgery were associated with new-onset persistent opioid use after surgery. These findings underscore the importance of minimizing opioid exposure in the perioperative period.
Learn more about opioid abuse.
The FLACC scale is a validated tool recommended for assessing postoperative pain in children 2 months to 19 years of age. However, it may be less suitable for evaluating procedural pain. In preverbal or nonverbal children with cognitive impairments, standard FLACC assessments can be less reliable. In such cases, the revised FLACC scale, which incorporates individualized behavioral cues, may offer a more accurate assessment.
Learn more about pain assessment.
Combined guidelines from the World Society of Emergency Surgery, Global Alliance for Infection in Surgery, Italian Society of Anesthesia, Analgesia, and Resuscitation, and the American Association for the Surgery of Trauma recommend multimodal analgesia, rather than the use of a single class of drugs, to manage postoperative pain. This approach enhances pain relief and helps reduce opioid consumption as well as adverse effects associated with a single drug class. In the absence of contraindications, acetaminophen, gabapentinoids, and nonsteroidal anti-inflammatory drugs are recommended as components of multimodal anesthesia. A step-up strategy that incorporates major opioid drugs when necessary should be employed.
The Centers for Disease Control and Prevention similarly recommends a multimodal approach in their opioid prescribing guidelines.
Learn more about perioperative medication management.
IV administration provides the most rapid onset of analgesia but does not offer superior pain control compared to the oral route. As such, IV analgesics should be reserved for situations where oral administration is not feasible, as in cases of gastrointestinal dysfunction. Postoperative pain management guidelines concur that the oral route is the preferred route of postoperative analgesic administration.
Learn more about local and regional anesthesia.
Guidelines state that the TAP block is both a safe and effective approach to managing postoperative pain. Abdominal wall blocks serve as an effective component of multimodal analgesia, contributing to opioid-sparing strategies. TAP blocks have been shown to significantly reduce pain scores at 12 hours postoperatively.
For laparoscopic abdominal procedures, a rectus sheath block may be considered an appropriate alternative to a TAP block within a multimodal analgesia plan.
Learn more about the TAP block.