Postoperative Pain Management in Enhanced Recovery Pathways

Christopher K Cheung, Janet O Adeola, Sascha S Beutler, Richard D Urman Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USACorrespondence: Richard D UrmanDepartment of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, CWN L1, Boston, MA, 02115, USATel +1 617 732 8210Fax +1 617 264 6841Email rurman@bwh.harvard.eduAbstract: Postoperative pain is a common but often inadequately treated condition. Enhanced recovery pathways (ERPs) are increasingly being utilized to standardize perioperative care and improve outcomes. ERPs employ multimodal postoperative pain management strategies that minimize opioid use and promote recovery. While traditional opioid medications continue to play an important role in the treatment of postoperative pain, ERPs also rely on a wide range of non-opioid pharmacologic therapies as well as regional anesthesia techniques to manage pain in the postoperative setting. The evidence for the use of these interventions continues to evolve rapidly given the increasing focus on enhanced postoperative recovery. This article reviews the current evidence and knowledge gaps pertaining to commonly utilized modalities for postoperative pain management in ERPs.Keywords: enhanced recovery after surgery, ERAS, multimodal analgesia, opioid-sparing analgesia, postsurgical pain, pain management