What is the management strategy for postoperative pain?

From the Guidelines

Effective postoperative pain management requires a multimodal approach combining different medications and techniques to optimize pain control while minimizing side effects. The management strategy for postoperative pain should prioritize a combination of non-opioid medications, including scheduled acetaminophen and NSAIDs, as the cornerstone of treatment, as recommended by the most recent guidelines 1.

• The use of acetaminophen (1000mg every 6 hours) and NSAIDs like ketorolac (15-30mg IV every 6 hours for 2-3 days) or ibuprofen (400-600mg every 6 hours) is recommended for patients without contraindications.
• Opioids such as morphine (2-4mg IV every 4 hours as needed), hydrocodone/acetaminophen (5-10mg/325mg every 4-6 hours as needed), or oxycodone (5-10mg every 4-6 hours as needed) should be reserved for breakthrough pain rather than as primary therapy to reduce respiratory depression and dependence risks, as supported by evidence from 1.
• Regional anesthesia techniques like nerve blocks or epidural analgesia can significantly reduce opioid requirements for major surgeries, as noted in 1.
• Non-pharmacological approaches including early mobilization, proper positioning, cold therapy, and psychological techniques like guided imagery complement medication management, as suggested by 1. Pain should be regularly assessed using standardized scales, with treatment adjusted based on patient response, to ensure optimal pain control and minimize adverse effects, as emphasized in 1. This multimodal approach targets different pain pathways simultaneously, providing superior analgesia while reducing medication-related adverse effects and supporting faster recovery.

From the FDA Drug Label

2 DOSAGE AND ADMINISTRATION

Dosage and Administation: 2. 1 Important Dosage and Administration Instructions Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals [see Warnings and Precautions (5)] Initiate the dosing regimen for each patient individually, taking into account the patient's severity of pain, patient response, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse [see Warnings and Precautions (5. 1)] . Monitor patients closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy and following dosage increases with oxycodone hydrochloride tablets and adjust the dosage accordingly [see Warnings and Precautions (5.3)] .

The management strategy for postoperative pain involves using the lowest effective dosage of oxycodone for the shortest duration consistent with individual patient treatment goals. The dosing regimen should be initiated individually, taking into account the patient's severity of pain, patient response, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse 2.

• Key considerations for managing postoperative pain with oxycodone include:
  • Initiating treatment with a dosing range of 5 to 15 mg every 4 to 6 hours as needed for pain
  • Titration of the dose based on the individual patient's response to their initial dose
  • Monitoring patients closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy and following dosage increases
  • Adjusting the dosage accordingly to balance pain control and adverse experiences 2

From the Research

Management Strategy for Postoperative Pain

The management of postoperative pain is a crucial aspect of patient care, as it can significantly impact recovery, hospital stay, and patient satisfaction. The following are key considerations for managing postoperative pain:

• A multidisciplinary team approach should be pursued, taking into account the patient's medical, psychological, and physical condition, age, level of fear or anxiety, surgical procedure, personal preference, and response to agents given 3.
• The major goal in the management of postoperative pain is minimizing the dose of medications to lessen side effects while still providing adequate analgesia 3.
• Constant assessment of pain intensity is recommended for optimal postoperative pain control, which can be achieved pharmacologically with monitoring of side-effects 4.
• Multi-modal analgesia is recommended, combining different drug classes, such as an opioid with a non-opioid, delivered through various routes, and including neuraxial use of local anesthetics alone or in combination with other drugs 4.

Factors Influencing Postoperative Pain Management

Several factors can influence postoperative pain management, including:

• Type of surgery and disease motivating surgery 4
• Patient-related factors, such as age, pain threshold, socio-cultural factors, and personality 4
• Setting-related factors, such as pre-operative information and relationship with medical staff 4
• Presence of medical comorbidities, which may increase the risk of analgesia-related complications or side effects 3

Therapeutic Approaches for Postoperative Pain

Various therapeutic approaches can be used to manage postoperative pain, including:

• Non-opioid analgesics, such as non-steroidal anti-inflammatory drugs, gabapentinoids, ketamine, α-2 agonists, and corticosteroids 5
• Regional anesthetic techniques, which can be used alone or in combination with other drugs 5
• Multi-modal analgesia, which combines different drug classes and routes of administration 4
• Enhanced Recovery After Surgery (ERAS) protocols, which provide guidance to promote recovery and prevent chronic postoperative pain 6