Practical issues in postoperative pain management: pain assessment and personalized choice of analgesics (review)

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Abstract

This review focuses on the critical aspects of rational postoperative pain management in surgical hospitals, emphasizing a multimodal, opioid-sparing approach. We discuss the principles of evidence-based analgesia, including the importance of using validated pain scales for consistent pain assessment and defining pain thresholds for initiating and modifying analgesic therapies. Defining target pain levels is crucial for guiding therapeutic interventions and achieving optimal pain relief. This paper describes a systematic and multi-modal approach to analgesic selection, emphasizing the combination of non-opioid analgesics like paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) with opioid analgesics, regional analgesia, and non-pharmacological interventions. Continuous evaluation of pain levels and response to therapy is essential for ensuring effective pain control and minimizing the risk of complications. The review highlights the potential benefits of preoperative analgesia in reducing opioid requirements and the incidence of chronic neuropathic pain. We discuss the unique challenges of pain management in children, emphasizing the need for age-appropriate dosing and administration routes, taking into account the physiological differences between adults and children. The review emphasizes the crucial role of individualizing pain management strategies based on patient characteristics including age, co-morbidities, drug tolerance, and genetic factors. We discuss the impact of genetic polymorphisms in CYP2C9 and CYP2D6 enzymes on NSAID and opioid metabolism in relation to optimizing both efficacy and safety. This review provides a comprehensive overview of the principles and practices for rational postoperative pain management, aiming to improve pain control, reduce opioid use, minimize adverse drug reactions, and enhance patient satisfaction and quality of life following surgical interventions. Implementing standardized pain assessment tools and protocols, utilizing a multi-modal analgesic approach, emphasizing preventive analgesia strategies, considering genetic factors in individual treatment plans, and prioritizing patient education and shared decision-making are key recommendations for healthcare professionals involved in the postoperative management of surgical patients. By adopting these evidence-based recommendations, we can strive to deliver optimal pain relief and enhance the overall recovery experience for patients.

About the authors

Vitaly A. Otdelenov

Priorov National Medical Research Center of Traumatology and Orthopedics; Russian Medical Academy of Continuing Professional Education

Author for correspondence.
Email: vitotd@yandex.ru
ORCID iD: 0000-0003-0623-7263
SPIN-code: 8357-5770

MD, Сand. Sci. (Medicine)

Russian Federation, 10 Priorova str., 127299 Moscow; Moscow

Natalia P. Denisenko

Russian Medical Academy of Continuing Professional Education

Email: natalypilipenko3990@gmail.com
ORCID iD: 0000-0003-3278-5941
SPIN-code: 5883-6249

MD, Сand. Sci. (Medicine)

Russian Federation, Moscow

Natalia I. Sobur

Russian Medical Academy of Continuing Professional Education

Email: nisoburm.d@gmail.com
ORCID iD: 0009-0007-8100-4079

MD, resident

Russian Federation, Moscow

Elena B. Kleymenova

Priorov National Medical Research Center of Traumatology and Orthopedics; Russian Medical Academy of Continuing Professional Education

Email: kleymenovaeb@cito-priorov.ru
ORCID iD: 0000-0002-8745-6195
SPIN-code: 2037-7164

MD, Dr. Sci. (Medicine), professor

Russian Federation, 10 Priorova str., 127299 Moscow; Moscow

Anton G. Nazarenko

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: nazarenkoag@cito-priorov.ru
ORCID iD: 0000-0003-1314-2887
SPIN-code: 1402-5186

MD, Dr. Sci. (Medicine), professor of RAS

Russian Federation, 10 Priorova str., 127299 Moscow

Israil M. Gairabekov

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: israil951998@gmail.com
ORCID iD: 0009-0006-6298-7084
Russian Federation, 10 Priorova str., 127299 Moscow

Karin B. Mirzaev

Russian Medical Academy of Continuing Professional Education

Email: karin05doc@yandex.ru
ORCID iD: 0000-0002-9307-4994
SPIN-code: 8308-7599

MD, Dr. Sci. (Medicine), professor

Russian Federation, Moscow

Dmitry A. Sychev

Russian Medical Academy of Continuing Professional Education

Email: dmitriy.alex.sychev@gmail.com
ORCID iD: 0000-0002-4496-3680
SPIN-code: 4525-7556

MD, Dr. Sci. (Medicine), professor; academician of the RAS

Russian Federation, Moscow

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2. Fig. 1. Stepwise multimodal postoperative analgesia. Note. * The drugs are included in the list of essential and vital medicines, † the use of gabapentinoids should be considered for surgical interventions associated with a high risk of neuropathic pain, such as arthroplasty, spinal surgery, limb amputation, etc. НПВП — nonsteroidal anti-inflammatory drugs.

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