Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council - 01/02/16
, Debra B. Gordon †, Oscar A. de Leon-Casasola ‡, Jack M. Rosenberg §, Stephen Bickler ¶, Tim Brennan ‖, Todd Carter ∗∗, Carla L. Cassidy ††, Eva Hall Chittenden ‡‡, Ernest Degenhardt §§, Scott Griffith ¶¶, Renee Manworren ‖‖, Bill McCarberg ∗∗∗, Robert Montgomery †††, Jamie Murphy ‡‡‡, Melissa F. Perkal §§§, Santhanam Suresh ¶¶¶, Kathleen Sluka ‖‖‖, Scott Strassels ∗∗∗∗, Richard Thirlby ††††, Eugene Viscusi ‡‡‡‡, Gary A. Walco §§§§, Lisa Warner ¶¶¶¶, Steven J. Weisman ‖‖‖‖, Christopher L. Wu ‡‡‡Abstract |
Most patients who undergo surgical procedures experience acute postoperative pain, but evidence suggests that less than half report adequate postoperative pain relief. Many preoperative, intraoperative, and postoperative interventions and management strategies are available for reducing and managing postoperative pain. The American Pain Society, with input from the American Society of Anesthesiologists, commissioned an interdisciplinary expert panel to develop a clinical practice guideline to promote evidence-based, effective, and safer postoperative pain management in children and adults. The guideline was subsequently approved by the American Society for Regional Anesthesia. As part of the guideline development process, a systematic review was commissioned on various aspects related to various interventions and management strategies for postoperative pain. After a review of the evidence, the expert panel formulated recommendations that addressed various aspects of postoperative pain management, including preoperative education, perioperative pain management planning, use of different pharmacological and nonpharmacological modalities, organizational policies, and transition to outpatient care. The recommendations are based on the underlying premise that optimal management begins in the preoperative period with an assessment of the patient and development of a plan of care tailored to the individual and the surgical procedure involved. The panel found that evidence supports the use of multimodal regimens in many situations, although the exact components of effective multimodal care will vary depending on the patient, setting, and surgical procedure. Although these guidelines are based on a systematic review of the evidence on management of postoperative pain, the panel identified numerous research gaps. Of 32 recommendations, 4 were assessed as being supported by high-quality evidence, and 11 (in the areas of patient education and perioperative planning, patient assessment, organizational structures and policies, and transitioning to outpatient care) were made on the basis of low-quality evidence.
Perspective |
This guideline, on the basis of a systematic review of the evidence on postoperative pain management, provides recommendations developed by a multidisciplinary expert panel. Safe and effective postoperative pain management should be on the basis of a plan of care tailored to the individual and the surgical procedure involved, and multimodal regimens are recommended in many situations.
Le texte complet de cet article est disponible en PDF.Highlights |
• | This guideline, developed based on a systematic review of the evidence, provides recommendations developed by a multidisciplinary expert panel on management of postoperative pain. |
• | The panel concluded that optimal postoperative pain management begins in the preoperative period and is made on the basis of an assessment of the patient and development of a plan of care tailored to the individual and the surgical procedure involved, with follow-up assessments and adjustments as needed. |
• | The panel recommended multimodal regimens in many situations, although the exact components will vary depending on the patient, setting, and surgical procedure. |
• | The panel identified a number of key research gaps, including the optimal methods for managing patients receiving opioids before surgery, the effectiveness of opioid-sparing multimodal regimens, and in a number of areas related to management of perioperative pain in infants and children. |
Key words : Postoperative pain management, clinical practice guidelines, analgesia, education, multimodal therapy, patient assessment, regional analgesia, neuraxial analgesia
Plan
| Funding for this guideline was provided by the American Pain Society. The guideline was submitted for approval by the partnering organizations, but the content of the guideline is the sole responsibility of the authors and panel members. |
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| All panelists were required to disclose conflicts of interest within the preceding 5 years at all face-to-face meetings and before submission of the guideline for publication, and to recuse themselves from votes if a conflict was present. Conflicts of interest of the authors and panel members are listed in Supplementary Appendix 1. |
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| Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com. |
Vol 17 - N° 2
P. 131-157 - février 2016 Retour au numéro
Article précédent
- Table of Contents
- Research Gaps in Practice Guidelines for Acute Postoperative Pain Management in Adults: Findings From a Review of the Evidence for an American Pain Society Clinical Practice Guideline
- Debra B. Gordon, Oscar A. de Leon-Casasola, Christopher L. Wu, Kathleen A. Sluka, Timothy J. Brennan, Roger Chou
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