Pain management in surgery

Evidence-Based Clinical Guidelines for Pain Management in Surgery

Published Materials

• Summary Brochure
• Evidence Document

Opioids continue to be prescribed after surgical procedures, yet patients often use fewer pills than prescribed.¹ A guideline designed to reduce opioid prescribing suggests that opioids can be reduced without changing patient satisfaction or pain control.² Clinicians need to understand the other options to address post-operative pain when reliance on opioids is decreased.

The goal of this educational program is to address the need for safe, effective pain relief in the peri-operative setting, which includes the pre-operative, intra-operative, and post-operative phases, while minimizing adverse effects of analgesics like opioids.

Planning for pain management occurs across the care pathway

Patient and caregiver education may be the most critical part of the pain management plan. Engaging in conversations about the reality of the post-operative recovery process can help caregivers and patients set reasonable expectations.

When discussing expectations:

1. Address common questions
   • What is the recovery time for the procedure?
   • What can I expect for post-operative pain and energy levels?
   • What should caregivers expect for length of stay and discharge planning?
2. Individualize the message
3. Talk about the pain management strategies that will be used

Strategies to treat pain should encompass a variety of modalities and be tailored to patient characteristics and response to treatment.

Components of a multi-modal pain plan³

^* Routine and should be available to all patients unless contraindicated  ^† not routine and given only as indicated.

The goal is to manage pain with safe, effective options, not simply to eliminate opioids. If opioids are required, prescribe the smallest quantity for the shortest amount of time. Educate patients about how to stop taking opioids, store opioids safely, and dispose of any unused medication.

Resources for Providers

• OPEN website

Information current at time of publication, August 2022.

The content of this website is educational in nature and includes general recommendations only; specific clinical decisions should only be made by a treating clinician based on the individual patient’s clinical condition.

References

1. Colton IB, Fujii MH, Ahern TP, et al. Postoperative opioid prescribing patterns and use after vascular surgery. Vasc Med. 2019;24(1):63-69.
2. Vu JV, Howard RA, Gunaseelan V, Brummett CM, Waljee JF, Englesbe MJ. Statewide implementation of postoperative opioid prescribing guidelines. N Engl J Med. 2019;381(7):680-682.
3. Mariano ER, Schatman ME. A Commonsense Patient-Centered Approach to Multimodal Analgesia Within Surgical Enhanced Recovery Protocols. J Pain Res. 2019 Dec 24;12:3461-3466.