5 things to know about American Pain Society's postsurgical pain management guideline

The American Pain Society released a new guideline for postsurgical pain management, and the Physician-Patient Alliance for Health & Safety summarized the key takeaways.

An interdisciplinary expert panel with input from the American Society of Anesthesiologists developed the guideline, which the American Society of Regional Anesthesia and Pain Management approved. Roger Chou, MD, was the lead author of the guideline for postsurgical pain management.

Here are five things to know about the new guideline:

1. The guideline instructs clinicians to consider the best pain alternatives for each patient to employ a multimodal pain strategy. The strategy can target different mechanisms in the peripheral and central nervous system. Studies show combinations of medications acting on different pain receptors or administered through various techniques can decrease opioid use and improve pain relief.

2. The guideline recommends acetaminophen and/or non-steroidal anti-inflammatory drugs for both adults and children as part of the multimodal analgesia postoperative pain management.

3. For children, the guideline suggests considering site-specific peripheral regional anesthetic techniques.

4. The guideline says spinal analgesia is appropriate for the major thoracic and abdominal procedures especially for patients who are at risk for pulmonary complications or prolonged intestinal distress.

5. The APS panel recommended continuously assessing and monitoring patients on pain medication, especially opioids. The guideline stresses:

• Preoperative evaluations, including medical and psychiatric comorbidities
• Adjusting pain management plans based on adverse events
• Track patient responses to pain treatment with validated pain assessment tools
• Monitor sedation, respirator status and adverse events appropriately for opioid users
• Monitor patients who receive neuraxial interventions for perioperative analgesia appropriately

"It's time for a change in how we monitor postoperative patients receiving opioids," said Robert Stoelting, MD, APS president. "We need a complete paradigm shift in how we approach safer care for postoperative patients receiving opioids."

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