The Role of Opioids and Non-Opioids in Postoperative Pain Relief; A Narrative Review
,
Abstract
Postoperative analgesia is one of the important basics of practical recovery after surgery. Pain relief has an important physiological advantage in preventing acute pain turning into a chronic pain and aims at early mobilization with decreasing infection, healing wound time, and hospital stay and /or hospital readmission in addition to eliminating adverse effect related to over sedation. Estimation of postoperative analgesia technique depends on the intensity of dynamic pain and the possible side effects of analgesic medications and techniques which can delay discharge. The key role in improving postoperative pain relates to three steps; 1. Patient education in the decision concerning their specific treatment. 2. Team skills and knowledge for different drugs and technique like acute pain services available towards 24 hours/ day. 3, Physician in communication with the patient is the essential point. Using low dose of opioid drug with NSAIDs or synergistic analgesia or multimodal analgesia at various points along pain pathway to support pain relief with less adverse effect is becoming increasingly common for post-operative pain relief.
Garcia JBS, Bonilla P, Kraychette DC, Flores FC, de Valtolina EDP, Guerrero C. Optimizing post-operative pain management in Latin America. Braz J Anesthesiol (English Edition). 2017; 67(4):395-403.
Lovich-Sapola J, Smith CE, Brandt CP. Postoperative pain control. Surgical Clinics. 2015; 95(2):301-18.
Rawal N. Current issues in postoperative pain management. Eur J Anaesthesiology . 2016;33(3):160-71.
Meissner W, Coluzzi F, Fletcher D, Huygen F, Morlion B, Neugebauer E, et al. Improving the management of post-operative acute pain: priorities for change. Curr Med Res Opin. 2015; 31(11):2131-43.
Corke P. Postoperative pain management. Australian Prescriber. 2013; 36(6):202-5.
Wells N, Pasero C, McCaffery M. Improving the quality of care through pain assessment and management. Science Direct. 2014; 29(1):1.
Thomas MA. Pain management–the challenge. The Ochsner Journal. 2003; 5(2):15-21.
Mackintosh C. Assessment and management of patients with post-operative pain. Nursing Standard. 2007; 22(5):49-55.
Schafheutle EI, Cantrill JA, Noyce PR. Why is pain management suboptimal on surgical wards? J Adv Nurs. 2001; 33(6):728-37.
Manias E, Bucknall T, Botti M. Nurses’ strategies for anaging pain in the postoperative setting. Pain Manag Nurs. 2005; 6(1):18-29.
Dihle A, Bjølseth G, Helseth S. The gap between saying and doing in postoperative pain management. J Clin Nurs. 2006; 15(4):469-79.
Schoenwald A, Clark CR. Acute pain in surgical patients. Contemp Nurse. 2006; 22(1):97-108.
Ivani G, Suresh S, Ecoffey C, Bosenberg A, Lonnqvist P-A, Krane E, et al. The European Society of Regional Anaesthesia and Pain Therapy and the American Society of Regional Anesthesia and Pain Medicine joint committee practice advisory on controversial topics in pediatric regional anesthesia. Reg Anesth Pain Med. 2015; 40(5):526-32.
Esaki R, Macario A. Analgesics: Opioids for Chronic Pain Management and Surgical Considerations. InEssentials of Pharmacology for Anesthesia, Pain Medicine, and Critical Care 2015 (pp. 125-145). Springer New York.
Reisner L. Pharmacological management of persistent pain in older persons. J Pain. 2011; 12(3):S21-9.
Brant JM. Practical approaches to pharmacologic management of pain in older adults with cancer. Oncol Nurs Forum. 2010; 37 Suppl:17-26.
Bergmans G, Vanacker B, Van Aken H, Noordui H, Van Peer A, Gryseels J, et al. Investigation of the pharmacokinetics and analgesic effects of an intramuscular injection of sustained-release sufentanil for postoperative pain: an open study. J Clin Anesth. 1994; 6(6):462-8.
Jarzyna D, Jungquist CR, Pasero C, Willens JS, Nisbet A, Oakes L, et al. American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression. Pain Manag Nurs. 2011; 12(3):118-145.e10.
Savoia G, Loreto M, Gravino E. Sufentanil: an overview of its use for acute pain management. Minerva Anestesiol. 2001; 67(9 Suppl 1):206-16.
Bailey PL, Streisand JB, East KA, East TD, Isern S, Hansen TW, et al. Differences in magnitude and duration of opioid-induced respiratory depression and analgesia with fentanyl and sufentanil. Anesth Analg. 1990;70(1):8-15.
Kisilewicz M, Rosenberg H, Vaillancourt C. Remifentanil for procedural sedation: a systematic review of the literature. Emerg Med J. 2017; 34(5):294-301.
Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL. Miller's Anesthesia E-Book: Elsevier Health Sciences; 2014.
Pasero C, McCaffery M. Pain assessment and pharmacologic management: Elsevier Health Sciences; 2010.
Persons O. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009; 57(8):1331-46.
Cepeda MS, Farrar JT, Baumgarten M, Boston R, Carr DB, Strom BL. Side effects of opioids during short‐term administration: Effect of age, gender, and race. Clin Pharmacol Ther. 2003; 74(2):102-12.
Malec M, Shega JW. Pain management in the elderly. Med Clin North Am. 2015; 99(2):337-50.
Wallace J, Paauw DS. Appropriate prescribing and important drug interactions in older adults. Med Clin North Am. 2015; 99(2):295-310.
Wooten JM. Rules for improving pharmacotherapy in older adult patients: part 1 (rules 1-5). South Med J. 2015; 108(2):97-104.
Chung C. The use of injectable nonsteroidal antiinflammatory drugs in local accident and emergency practice. Hong Kong J Emerg Med. 2002; 9(2):65-71.
Schug SA, Manopas A. Update on the role of non-opioids for postoperative pain treatment. Best Practice & Research Clinical Anaesthesiology. 2007; 21(1):15-30.
Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth. 2001;87(1):62-72.
Power I, Barratt S. Analgesic agents for the postoperative period: nonopioids. Surg Clin North Am. 1999;79(2):275-95.
White PF. What are the advantages of non-opioid analgesic techniques in the management of acute and chronic pain? Expert Opin Pharmacother. 2017 ;18(4):329-33.
Dahl JB, Kehlet H. Preventive analgesia. Curr Opin Anaesthesiol. 2011; 24(3):331-8.
Konijnenbelt‐Peters J, Heijden C, Ekhart C, Bos J, Bruhn J, Kramers C. Metamizole (Dipyrone) as an Alternative Agent in Postoperative Analgesia in Patients with Contraindications for Nonsteroidal Anti‐Inflammatory Drugs. Pain Pract. 2017;17(3):402-8.
De Oliveira Jr GS, Agarwal D, Benzon HT. Perioperative single dose ketorolac to prevent postoperative pain: a meta-analysis of randomized trials. Anesth Analg. 2012; 114(2):424-33.
Chen JY, Wu GJ, Mok M, Chou YH, Sun WZ, Chen PL, et al. Effect of adding ketorolac to intravenous morphine patient‐controlled analgesia on bowel function in colorectal surgery patients–a prospective, randomized, double‐blind study. Acta Anaesthesiol Scand. 2005; 49(4):546-51.
Yee JP, Koshiver JE, Allbon C, Brown CR. Comparison of intramuscular ketorolac tromethamine and morphine sulfate for analgesia of pain after major surgery. Pharmacotherapy. Pharmacotherapy. 1986; 6(5):253-61.
Bugada D, Lavand'Homme P, Ambrosoli AL, Klersy C, Braschi A, Fanelli G, et al. Effect of postoperative analgesia on acute and persistent postherniotomy pain: a randomized study. J Clin Anesth. 2015; 27(8):658-64.
Farshchi A, Ghiasi G. Comparison the analgesic effects of single dose administration of tramadol or piroxicam on postoperative pain after cesarean delivery. Acta Med Iran. 2010; 48(3):148-53.
Coloma M, White PF, Huber Jr PJ, Tongier WK, Dullye KK, Duffy LL. The effect of ketorolac on recovery after anorectal surgery: intravenous versus local administration. Anesth Analg. 2000; 90(5):1107-10.
Iorno V, Landi L, Di Pasquale R, Cicenia S, Moschini V. Comparison of intravenous ketorolac with or without paracetamol in postoperative pain control following ambulatory surgery. Curr Med Res Opin. 2013; 29(12):1685-90.
Rosero EB, Joshi GP. Preemptive, preventive, multimodal analgesia: what do they really mean? Plast Reconstr Surg. 2014; 134(4S-2):85S-93S.
Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesth Analg. 2004;98(1):153-8.
Tufanogullari B, White PF, Peixoto MP, Kianpour D, Lacour T, Griffin J, et al. Dexmedetomidine infusion during laparoscopic bariatric surgery: the effect on recovery outcome variables. Anesth Analg. 2008;106(6):1741-8.
Kaur M, Singh P. Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesth Essays Res. 2011; 5(2):128-33.
Bockbrader HN, Wesche D, Miller R, Chapel S, Janiczek N, Burger P. A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin. Clin Pharmacokinet. 2010; 49(10):661-9.
Peng PW, Wijeysundera DN, Li CC. Use of gabapentin for perioperative pain control–a meta-analysis. Pain Res Manag. 2007; 12(2):85-92.
Zhang J, Ho K-Y, Wang Y. Efficacy of pregabalin in acute postoperative pain: a meta-analysis. Br J Anaesth.. 2011; 106(4):454-62.
Rai AS, Khan JS, Dhaliwal J, Busse JW, Choi S, Devereaux P, et al. Preoperative pregabalin or gabapentin for postoperative acute and chronic pain among patients undergoing breast cancer surgery: A systematic review and meta-analysis of randomized controlled trials. J Plast Reconstr Aesthet Surg. 2017; 70(10):1317-1328.
Cavalcante AN, Sprung J, Schroeder DR, Weingarten TN. Multimodal Analgesic Therapy With Gabapentin and Its Association With Postoperative Respiratory Depression. Anesth Analg. 2017; 125(1):141-6.
Lavand’homme P, De Kock M, Waterloos H. Intraoperative epidural analgesia combined with ketamine provides effective preventive analgesia in patients undergoing major digestive surgery. Anesthesiology. 2005; 103(4):813-20.
Guignard B, Coste C, Costes H, Sessler DI, Lebrault C, Morris W, et al. Supplementing desflurane-remifentanil anesthesia with small-dose ketamine reduces perioperative opioid analgesic requirements. Anesth Analg. 2002; 95(1):103-8.
Asadi HK, Nikooseresht M, Noori L, Behnoud F. The effect of administration of ketamine and paracetamol versus paracetamol singly on postoperative pain, nausea and vomiting after pediatric adenotonsillectomy. Anesth Pain Med. 2016; 6(1): e31210.
Hval K, Thagaard KS, Schlichting E, Raeder J. The prolonged postoperative analgesic effect when dexamethasone is added to a nonsteroidal antiinflammatory drug (rofecoxib) before breast surgery. Anesth Analg. 2007 Aug;105(2):481-6.
Tan M, Law LS-C, Gan TJ. Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways. Can J Anaesth. 2015; 62(2):203-18.
De Oliveira GS, Almeida MD, Benzon HT, McCarthy RJ. Perioperative Single Dose Systemic Dexamethasone for Postoperative PainA Meta-analysis of Randomized Controlled Trials. Anesthesiology. 2011; 115(3):575-88.
Steinberg AC, Schimpf MO, White AB, Mathews C, Ellington DR, Jeppson P, et al. Preemptive analgesia for postoperative hysterectomy pain control: systematic review and clinical practice guidelines. Am J Obstet Gynecol. 2017; 217(3):303-313.e6.
Møiniche S, Kehlet H, Dahl JB. A Qualitative and Quantitative Systematic Review of Preemptive Analgesia for Postoperative Pain ReliefThe Role of Timing of Analgesia. Anesthesiology. 2002 Mar;96(3):725-41.
Korean KS. Guidelines for the management of postoperative pain after total knee arthroplasty. Knee Surg Relat Res. 2012; 24(4): 201–207.
Garimella V, Cellini C. Postoperative pain control. Clin Colon Rectal Surg. 2013; 26(3): 191–196.
Katz J, Clarke H, Seltzer Ze. Preventive analgesia: quo vadimus? Anesth Analg. 2011; 113(5):1242-53.
Jeffrey L, Michael A . Practice Guidelines for Acute Pain Management in the Perioperative SettingAn Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012; 116(2):248-73.
Kehlet H, Dahl JB. The value of" multimodal" or" balanced analgesia" in postoperative pain treatment. Anesth Analge. 1993;77(5):1048-56.
Zenz MW, Tryba M. Economic aspects of pain therapy. Current Opinion in Anesthesiology. 1996;9(5):430-5.
Fischer H, Simanski C. A procedure‐specific systematic review and consensus recommendations for analgesia after total hip replacement. Anaesthesia. 2005;60(12):1189-202.
Kehlet H. Postoperative Opioid Sparing to Hasten RecoveryWhat Are the Issues? Anesthesiology. 2005; 102(6):1083-5.
Zhou H, Jia WD, Qiao XF, Liu FP, Chen L, Hu CL.. Clinical values of multimodal preventive analgesia in patients with partial hepatectomy for liver cancer. Zhonghua Wai Ke Za Zhi [Chinese Journal of Surgery]. 2017; 55 (2):141-5.
Golembiewski J, Dasta J. Evolving role of local anesthetics in managing postsurgical analgesia. Clin Ther. 2015; 37(6):1354-71.
Girard P, Chauvin M, Verleye M. Nefopam analgesia and its role in multimodal analgesia: a review of preclinical and clinical studies. Clin Exp Pharmacol Physiol. 2016; 43(1):3-12.
Fearon K, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong C, Lassen K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005; 24(3):466-77.
Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010; 29(4):434-40.
Cathryn Matthews DH, Plymouth. ENHANCED RECOVERY AFTER SURGERY (ERAS)2010 [cited 2010 8TH NOVEMBER ].
Aarts M, Okrainec A, McCluskey S, Siddiqui N, Wood T, Pearsall E, et al. Enhanced Recovery after Surgery Guideline. 2016.
Mudge E OHWI. wound infection and pain management made easy 2010 ; 1(3).
Barie PS, Eachempati SR. Surgical site infections. Surg Clin North Am. 2005; 85(6):1115-35.
Anderson DJ. Surgical site infections. Infect Dis Clin North Am. 2011;25(1):135-53.
Torpy JM, Burke AE, Glass RM. Postoperative Infections. JAMA. 2010; 303(24):2544
Saeed KB, Greene RA, Corcoran P, O'Neill SM. Incidence of surgical site infection following caesarean section: a systematic review and meta-analysis protocol. Br Med J Open. 2017;7(1):e013037.
Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection,2017. JAMA Surg. 2017; 152(8):784-791.
| Files | ||
| Issue | Vol 4 No 1 (2018): Winter |
|
| Section | Review Article(s) | |
| Keywords | ||
| pain management analgesia opioids post-operative pain | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
