title: Optimal analgesia during major open and laparoscopic abdominal surgery.
abstract: Optimal analgesia is a key element of enhanced recovery after surgery (ERAS), not only for humanitarian reasons but also because poorly relieved surgical pain contributes to surgical stress and impairs recovery. A multimodal analgesic approach is advised in order to provide adequate analgesia, reduce opioid consumption, reduce side effects and facilitate the achievement of ERAS milestones. For open surgery, a thoracic epidural for 48 to 72 hours, with regular acetaminophen and antiinflammatories is probably the treatment of choice. For laparoscopic surgery, intrathecal or local anesthesia in the wound combined with regular acetaminophen and antiinflammatory drugs is effective.
authors.affiliation: Department of Anaesthesia, Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK; Faculty of Health and Medical Sciences, Duke of Kent Building, University of Surrey, Guildford GU2 7TE, UK. Electronic address: wfawcett@nhs.net.
authors.forename: William J
authors.initials: WJ
authors.lastname: Fawcett
authors.affiliation: Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, 1650 Avenue Cedar, Montreal, Quebec H3G 1A4, Canada.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Baldini
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000698:Analgesia / Q000379:methods*; D015360:Analgesia, Epidural / Q000379:methods; D000772:Anesthesia, Local; D006801:Humans; D007278:Injections, Spinal; D010535:Laparoscopy
keywords: Acetaminophen; Alpha-2 agonists; Analgesia; Anticonvulsants; Antiinflammatory agents; Local anesthetic; N-Methyl-d-aspartate (NMDA) receptor antagonist; Opioids