Two Key Takeaways from New American Pain Society Guideline for Post-Surgical Pain Management

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The Physician-Patient Alliance for Health & Safety (PPAHS) today released two key takeaways from the new American Pain Society Guideline for Post-Surgical Pain Management.

Appropriately monitor sedation, respiratory status, and other adverse events in patients who receive systemic opioids

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The Physician-Patient Alliance for Health & Safety (PPAHS) today released two key takeaways from the new American Pain Society Guideline for Post-Surgical Pain Management.

The American Pain Society (APS) recently released Clinical Practice Guideline for Post-Surgical Pain Management sets forth recommendations from an interdisciplinary expert panel. The APS commissioned the panel which received input from the American Society of Anesthesiologists (ASA), and the guideline was approved by the American Society of Regional Anesthesia and Pain Management (ASRA).

Roger Chou, MD, lead author and head of the Oregon Evidence-based Practice Center, says that the guideline targets at all clinicians involved with post-surgical pain:

The intent of the guideline is to provide evidence-based recommendations for better management of postoperative pain, and the target audience is all clinicians who manage pain resulting from surgery,

Here are two key takeaways from the 32 recommendations:

1. Use a MultiModal Pain Strategy

The APS guideline asks clinicians to stop and consider the best pain alternatives for each patient. Dr Chou emphasizes the need for a multimodal approach:

"The guideline strongly advises use of multimodal anesthesia that target different mechanisms of actions in the peripheral and central nervous systems. Randomized trails have shown that multimodal anesthesia involving simultaneous use of combinations of several medications -- acting on different pain receptors or administered through different techniques -- are associated with superior pain relief and decreased opioid consumption compared with use of a single medication administered by one technique."

The APS guideline indicates these three recommendations graded strong with high-quality evidence:

  • Adults and children can be given acetaminophen and/or non-steroidal anti-inflammatory drugs as part of multimodal analgesia for management of postoperative pain
  • Clinicians should consider surgical site-specific peripheral regional anesthetic techniques with proven efficacy in adults and children for certain procedures
  • Spinal analgesia is appropriate for major thoracic and abdominal procedures, particularly in patients at risk for cardiac and pulmonary complications or prolonged intestinal distress.

2. Carefully Monitor All Patients Receiving Pain Medication Particularly Opioids
The APS panel strongly recommends that clinicians continuously assess and monitor their patients receiving pain medication, particularly if it involves opioid administration:

  • Conduct a preoperative evaluation, including assessment of medical and psychiatric comorbidities, concomitant medications, history of chronic pain, and substance abuse;
  • Adjust the pain management plan on the basis of adequacy of pain relief and presence of adverse events;
  • Use a validated pain assessment tool to track response to postoperative pain treatments and adjust treatment plans accordingly;
  • Appropriately monitor sedation, respiratory status, and other adverse events in patients who receive systemic opioids; and
  • Provide appropriate monitoring of patients who have received neuraxial interventions for perioperative analgesia.

The Anesthesia Patient Safety Foundation (APSF) has called for a “paradigm shift” in monitoring patients. Robert Stoelting, MD (President, APSF) says:

"It’s time for a change in how we monitor postoperative patients receiving opioids. We need a complete paradigm shift in how we approach safer care for postoperative patients receiving opioids."

About Physician-Patient Alliance for Health & Safety
Physician-Patient Alliance for Health & Safety is a non-profit 501(c)(3) whose mission is to promote safer clinical practices and standards for patients through collaboration among healthcare experts, professionals, scientific researchers, and others, in order to improve health care delivery. For more information, please go to http://www.ppahs.org

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