Safety of treatment options available for postoperative pain

ABSTRACT

Introduction

Postoperative pain is one of the most common adverse events after surgery and has been shown to increase the risk of other complications. On the other hand, liberal opioid use in the perioperative period is also associated with risk of adverse events. The current consensus is therefore to provide multimodal, opioid minimizing analgesia after surgery.

Areas Covered

In this review, we will discuss the benefits and risks associated with non-opioid analgesics, including non-steroidal anti-inflammatory drugs, gabapentinoids, ketamine, α-2 agonists, and corticosteroids. In addition, we will discuss the general and block-specific risks associated with regional anesthestic techniques.

Expert Opinion

Adverse events associated with non-opioid analgesics are rare outside their specific contraindicated patient groups, especially when dosed appropriately. α-2 agonists can cause transient hypotension and bradycardia, and gabapentinoids may cause sedation in higher risk patient populations. Regional anesthesia techniques are generally safe when done by an experienced practitioner. We therefore encourage the development of standardized multimodal analgesic protocols, which may facilitate opioid minimization and lead to better patient outcomes.

KEYWORDS:

• Pain
• safety
• postoperative
• treatment

Article highlights

• Postoperative pain is the most common adverse events after surgery.

• While regional anesthesia techniques are safe and effective intervention for postoperative analgesia, this is often limited by the lack of resources, facility, and personnel.

• At subanesthetic doses, ketamine is opioid sparing and not associated with significantly increased risk of emergence delirium or postoperative cognitive decline.

• Intraoperative dexamethasone is an effective analgesic adjunct, while it is associated with transient hyperglycemia, there is limited evidence that it increases the risk of infection and bleeding.

• Dexmedetomidine is also an effective analgesic adjunct, and may prevent postoperative delirium; the risks of hypotension and bradycardia will need to be carefully managed.

• Gabapentin is an effective opioid sparing analgesic, but may synergize with opioids in causing sedation and respiratory depression, particularly in the elderly.

This box summarizes key points contained in the article.

Declaration of interest

TJ Gan received honoraria from Acacia, Edwards, Masimo, Medtronic, Merck and Mallinckrodt. 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 or other relationships to disclose.