From the Guidelines
General surgery conditions that have pain not relieved by analgesics include severe pancreatitis, extensive burns, major abdominal surgeries, thoracic surgeries, amputation with phantom limb pain, and complex trauma cases with multiple injuries. These conditions often require more advanced pain management strategies due to multiple pain mechanisms, including somatic, visceral, and neuropathic components, severe tissue inflammation, central sensitization, and psychological factors that amplify pain perception 1. Some of the advanced strategies may include:
- Patient-controlled analgesia (PCA)
- Regional anesthesia techniques like epidural analgesia
- Continuous peripheral nerve blocks
- Ketamine infusions
- Gabapentinoids for neuropathic components Early consultation with pain specialists is recommended for these challenging cases to optimize pain control and prevent the development of chronic pain syndromes 1. Key considerations in managing these conditions include a multimodal approach to pain management, tailored to the individual patient's needs, and a multidisciplinary team approach to care. The use of multimodal analgesia, including the combination of systemic and regional analgesia, is supported by recent guidelines as an effective strategy for managing postoperative pain in non-traumatic emergency general surgery 1. Overall, the management of pain in these general surgery conditions requires a comprehensive and individualized approach, taking into account the complex pathophysiology of pain and the need for multidisciplinary care.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
General Surgery Conditions with Pain Not Relieved by Analgesics
- Acute pancreatitis: Studies have shown that while analgesics can decrease the need for rescue analgesia and improve pain scores in patients with acute pancreatitis, the optimal analgesic strategy for patients with moderately severe and severe acute pancreatitis still needs to be determined 2.
- Postoperative pain: Poorly controlled postoperative pain is a common issue, with over 80% of patients in the US experiencing inadequate pain management after surgery, leading to increased morbidity, functional and quality-of-life impairment, and higher healthcare costs 3.
- Chronic pancreatitis: Opioid treatment is often required for painful chronic pancreatitis, but may have limitations, such as skin side effects and the need for rescue medication, highlighting the need for alternative analgesic strategies 4.
Specific Conditions with Limited Analgesic Efficacy
- Severe acute pancreatitis: The current evidence suggests that the optimal analgesic strategy for patients with severe acute pancreatitis is still unknown, and more research is needed to determine the most effective approach 2.
- Postoperative pain in certain surgical procedures: The type of surgery performed can impact the effectiveness of analgesic regimens, with some procedures being more prone to poorly controlled postoperative pain 3.
Alternative Analgesic Approaches
- Epidural blockade: Epidural blockade has been shown to be effective in managing pain in patients with acute pancreatitis, with some studies suggesting its use as an alternative to traditional analgesic regimens 5.
- Novel opioids: New opioids, such as oliceridine, have been developed to provide rapid postoperative analgesia with reduced adverse events, offering a potential alternative to conventional opioids 3.