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.
Goals
- 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
Phases of Perioperative Analgesia
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
Multimodal Analgesia
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
Considerations
- 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
Example: Neurosurgery (Scalp Blocks)
In craniotomies, scalp nerve blocks using bupivacaine ± clonidine can:
- Reduce intraoperative hemodynamic fluctuations
- Provide postoperative analgesia
- Reduce opioid requirements