Postoperative pain: a review of emerging therapeutic options

ABSTRACT

Introduction

Postoperative pain is often managed by opioid medications, even though they carry a risk of adverse effects such as vomiting, constipation, sedation, respiratory depression and physical dependence. Furthermore, opioid use in the healthcare setting has likely contributed to the epidemic. However, the mismanagement of postoperative pain can result in delayed recovery time, impaired physical function, increased risk of morbidity and mortality, chronic pain, and higher healthcare costs.

Areas covered

This review explores emerging therapeutic options and strategies in the management of acute postoperative pain and focuses on opioid-sparing, multimodal analgesia. This includes regional anesthetic techniques, non opioid pharmacotherapy, novel opioids and non-pharmacologic therapy. We have also discussed examples of novel analgesics and formulations which have potential benefits in reducing postoperative pain and opioid use after surgery.

Expert opinion

The development of novel regional anesthesia techniques allows for opioid minimization in increasing number of surgical procedures. This synergizes with the availability of novel non-opioid analgesic adjucts. In addition, several novel opioid drugs have been developed which may be pathway selective and associated with less adverse effect than conventional opioids.

KEYWORDS:

• Analgesic adjuncts
• Opioid
• Postoperative pain
• Regional anesthesia

Article Highlights

• Advances in motor sparing regional anesthesia options (including truncal blocks) has enabled use in a wider range of surgical procedures.

• Regional anesthesia adjuncts such as dexamethasone and dexmedetomidine, as well as catheter-based techniques can overcome the duration limitation associated with conventional techniques.

• Several licensed medications, such as dextromethorphan and steroids may be effective as perioperative analgesic adjuncts.

• Novel opioid receptor agonists such as oliceridine and tapentadol may have more favorable benefit/risk profile than conventional opioids.

• Other novel analgesic options are under investigation as a part of multimodal analgesic regimen or as rescue analgesics.

Declaration of interest

Tong J Gan has received honoraria from Acacia, Edwards, Masimo, Medtronic, Merck and Mallinckrodt. Sergio D Bergese has received Funding for Clinical Trial from Acacia. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.