New Insights Into the Pharmacological Management of Postoperative Pain: A Narrative Review
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Date
2022
Authors
Mayoral Rojals, Victor
Charaja, Moises
Leon, Oscar de
Montero Matamala, Antonio
Narvaez Tamayo, Marco Antonio
Varrassi, Giustino
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Abstract
Postoperative pain is prevalent and often undertreated. There is a risk that untreated or suboptimally
treated postoperative pain may transition into chronic postoperative pain, which can be challenging to treat.
Clinical guidelines recommend the use of multimodal analgesia, including non-steroidal anti-inflammatory
drugs (NSAIDs), acetaminophen, and, in some cases, opioids. NSAIDs are a broad class of drugs with
different attributes such as cyclo-oxygenase (COX)-1 or COX-2 selectivity, onset of action, and analgesic
potency. NSAIDs are associated with gastrointestinal and cardiovascular side effects and should be
administered at the lowest effective dose for the shortest effective duration but can be effective in
postoperative pain. The role of opioids in postoperative analgesia is long-standing but has recently come
under scrutiny. Opioids are often used in multimodal analgesic combinations in such a way as to minimize
the total consumption of opioids without sacrificing analgesic benefit. Special clinical considerations are
required for surgical patients already on opioid regimens or with opioid use disorder. A particularly useful
fixed-dose combination product for postoperative analgesia is dexketoprofen-tramadol, which confers safe
and effective postoperative pain control and reduces the risk of persistent postoperative pain.
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Cureus, 2022, vol. 14, núm. 3, art. 23037.