perioperative_analgesia

Perioperative analgesia refers to pain management strategies implemented before, during, and after surgery to reduce pain, improve recovery, and minimize complications. It is a critical component of multimodal perioperative care, especially in enhanced recovery after surgery (ERAS) protocols.

  • Prevent and control postoperative pain
  • Reduce stress response to surgery
  • Facilitate early mobilization and rehabilitation
  • Minimize opioid use and related side effects
  • Improve overall surgical outcomes

Preoperative Phase

  • Patient education and expectation setting
  • Pre-emptive analgesia: analgesics *before incision* (e.g. paracetamol, NSAIDs, gabapentinoids)
  • Optimization of comorbidities (e.g. renal function, anticoagulation)

Intraoperative Phase

  • Regional anesthesia: spinal, epidural, nerve blocks (e.g. scalp block, TAP block)
  • Systemic analgesics: opioids, NSAIDs, paracetamol, ketamine, lidocaine infusion
  • Adjuvants: clonidine, dexmedetomidine, magnesium sulfate

Postoperative Phase

  • Multimodal analgesia: combining different drug classes (e.g. paracetamol + NSAID + low-dose opioid)
  • Patient-controlled analgesia (PCA)
  • Continuation of regional techniques: epidural infusion, nerve catheter
  • Non-pharmacological methods: cold therapy, physical therapy

This is the cornerstone of effective perioperative pain management:

  • Opioid-sparing techniques
  • Use of regional blocks and non-opioid drugs
  • Reduces opioid-related side effects: nausea, sedation, ileus
  • Type and extent of surgery (minor vs. major)
  • Patient factors: age, renal/hepatic function, opioid tolerance
  • Risk of chronic post-surgical pain
  • Avoiding drug interactions and adverse effects

In craniotomies, scalp nerve blocks using bupivacaine ± clonidine can:

  • Reduce intraoperative hemodynamic fluctuations
  • Provide postoperative analgesia
  • Reduce opioid requirements
  • perioperative_analgesia.txt
  • Last modified: 2025/07/04 10:40
  • by administrador