A Short Review on the Current Status of Multimodal Analgesia for Postoperative Pain: How Recent Findings Suggest a Change in Perspective - Pages 88-96
Dario Bugada1,3, M. Di Matteo1,3, F. Intelligente4, F. Repetti1,3, S. Cattaneo2, F. Romagnoli2 and C. Minella2
1Department of Anaesthesia and Intensive Care – Foundation IRCCS Policlinico San Matteo, Pavia, Italy; 2Pain Therapy Service – Foundation IRCCS Policlinico San Matteo, Pavia, Italy; 3SIMPAR Group (Study In Multidisciplinary Pain Research); 4Day Surgery Unit – IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Postoperative pain (POP) management is still a challenge in everyday clinical practice, and despite therapeutic improvements of the last two decades, it still remains undertreated. POP influences peri-operative comorbidities and outcome, and can also become chronic, affecting patient’s quality of life and increasing costs for the health system.
POP is complex, as it is not purely inflammatory or neuropathic, but mixed; a multimodal approach combining different drugs and techniques (acting on different pain components) is mandatory, and is demonstrated to be a therapeutic approach to improve patient’s outcome. In this short review we present new evidences regarding different drugs and techniques currently used in multimodal analgesia protocols, and we explain how these evidences should lead to a change in perspective. Physicians should plan perioperative pain treatment to treat not only pain itself, but choosing the best treatment according to patient history, concomitant pathologies and type of surgery, in order to reduce perioperative comorbidities, chronic pain incidence and, thus, improving outcome.
Keywords: Post-operative pain, multimodal analgesia, regional anesthesia, surgical outcome.