What is a potential research title for anesthesia residents to investigate postoperative pain management in adult patients undergoing major surgery?

Research Title Proposals for Anesthesia Residents: Postoperative Pain Management After Major Abdominal Surgery

Anesthesia residents should investigate multimodal analgesia protocols comparing regional anesthesia techniques (epidural, intrathecal morphine, or truncal nerve blocks) combined with non-opioid adjuncts versus traditional opioid-based regimens, measuring patient-centered outcomes including quality of recovery, functional return, and persistent opioid use after major abdominal surgery. 1, 2, 3

Specific Research Title Options

Option 1: Regional Anesthesia Comparison

"Comparative Effectiveness of Thoracic Epidural Analgesia versus Intrathecal Morphine with Truncal Nerve Blocks on Quality of Recovery and Opioid Consumption After Open Abdominal Surgery: A Randomized Controlled Trial"

• This addresses the current shift away from epidural techniques toward intrathecal morphine and peripheral blocks in abdominal surgery 2
• Thoracic epidural analgesia (TEA) has demonstrated reduced paralytic ileus, improved intestinal blood flow, and decreased stress response in major abdominal procedures 1
• However, TEA is associated with higher rates of hypotension, motor weakness, and urinary retention requiring catheterization 1
• The comparison is clinically relevant as minimally invasive techniques have changed analgesic requirements 2

Option 2: Multimodal Protocol Development

"Development and Implementation of an Opioid-Sparing Multimodal Analgesia Protocol for Emergency Abdominal Surgery: Impact on Pain Scores, Opioid Consumption, and Hospital Length of Stay"

• Emergency surgery represents an understudied population with unique challenges 1
• Multimodal regimens combining acetaminophen (1g IV q6h), NSAIDs/COX-2 inhibitors, regional blocks, and IV lidocaine infusion (1-2 mg/kg bolus followed by 1-2 mg/kg/h) reduce opioid requirements and side effects 1
• This addresses the critical gap in emergency surgery pain management where most evidence comes from elective oncologic procedures 1

Option 3: Long-Term Outcomes Focus

"Effect of Intraoperative Neuraxial Analgesia on Development of Chronic Postsurgical Pain and Persistent Opioid Use at 3 and 6 Months After Major Abdominal Surgery"

• Up to 10% of opioid-naïve patients develop persistent opioid use after surgery 2
• Intraoperative epidural and particularly spinal analgesia reduce both incidence and extent of secondary mechanical hyperalgesia, which correlates with chronic postsurgical pain development 4
• This addresses patient-centered long-term outcomes including quality of life, return to function, and disability-free survival 2, 3

Option 4: Specific Adjunct Investigation

"Efficacy of Intravenous Lidocaine Infusion as Part of Multimodal Analgesia in Reducing Opioid Requirements and Enhancing Recovery After Major Abdominal Surgery: A Dose-Response Study"

• IV lidocaine (bolus 1-2 mg/kg followed by 1-2 mg/kg/h infusion) demonstrates analgesic, anti-hyperalgesic, and anti-inflammatory properties 1
• Limited data exists comparing lidocaine infusion directly to regional techniques 1
• This fills a knowledge gap for patients where regional analgesia is contraindicated or unavailable 1

Key Methodological Considerations

Primary Outcomes Should Prioritize

• Pain scores at rest and with movement at 24,48, and 72 hours postoperatively using validated scales 1, 3
• Total opioid consumption in morphine milligram equivalents over 72 hours 1, 3
• Quality of recovery scores using validated instruments (QoR-15 or QoR-40) 2, 3

Secondary Outcomes Must Include

• Time to first mobilization and return to functional activities 1
• Opioid-related adverse events: nausea, vomiting, sedation, respiratory depression, ileus 1, 3
• Length of hospital stay and time to discharge readiness 1
• Chronic pain incidence at 3 and 6 months with assessment of mechanical hyperalgesia 4, 2
• Persistent opioid use at 3 and 6 months in opioid-naïve patients 2

Essential Protocol Components

• Standardized multimodal baseline: All groups should receive scheduled acetaminophen (1g IV q6h) and NSAIDs/COX-2 inhibitors unless contraindicated 1, 3
• Preemptive analgesia: Administer analgesics before surgical incision 1, 3
• Dexamethasone 8mg IV at induction for anti-inflammatory and analgesic effects 1, 5
• Rescue analgesia protocol: Standardized IV opioid titration for breakthrough pain 1, 3

Common Pitfalls to Avoid

• Do not use vital signs as pain assessment tools - they are unreliable predictors and do not correlate with self-reported pain 1
• Avoid acetaminophen in patients with liver disease - monitor liver enzymes as doses sufficient for analgesia can increase ALT 1
• Do not combine NSAIDs with therapeutic anticoagulation - this multiplies bleeding risk by 2.5-fold 1
• Ensure planned removal process for continuous wound catheters with appropriate transition analgesia 1
• Monitor for epidural-related complications: hypotension requiring intervention, motor block delaying mobilization, and urinary retention 1

Research Gap Justification

Current evidence demonstrates that less than half of surgical patients report adequate postoperative pain relief despite available interventions 3. The shift toward minimally invasive abdominal surgery has created uncertainty about optimal analgesic techniques, with declining epidural use and increasing interest in alternatives 2. Most critically, limited research exists on patient quality of recovery using specific analgesic techniques, and long-term outcomes including persistent pain and opioid use remain understudied 2, 3. These proposals address high-priority gaps with direct implications for patient morbidity, mortality, and quality of life 2, 3.