Multimodal analgesia

Multimodal analgesia: Optimal pain management while avoiding opioids is a key enabler of patient recovery. Furthermore, poor acute pain management is a strong risk factor for the development of chronic pain. A multimodal approach is recommended, using multiple strategies before, during and after surgery.

Postoperatively: patients are prescribed routine (not PRN) acetominophen 1gm q6hours and nonsteroidal antiinflammatory agents (NSAIDs), althought there remains some controversy over whether NSAIDs increase leak rates (1). Opioids are given only if adequate analgesia (<4/10) is not obtained with all of the above.

For more information, see Chapter 13: Choosing Analgesia to Facilitate Recovery in The SAGES / ERAS® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery

1. Gorissen KJ1, Benning D, Berghmans T, Snoeijs MG, Sosef MN, Hulsewe KW, Luyer MD. Risk of anastomotic leakage with non-steroidal anti-inflammatory drugs in colorectal surgery. Br J Surg. 2012 May;99(5):721-7

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