title: Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council.
abstract: Most patients who undergo surgical procedures experience acute postoperative pain, but evidence suggests that less than half report adequate postoperative pain relief. Many preoperative, intraoperative, and postoperative interventions and management strategies are available for reducing and managing postoperative pain. The American Pain Society, with input from the American Society of Anesthesiologists, commissioned an interdisciplinary expert panel to develop a clinical practice guideline to promote evidence-based, effective, and safer postoperative pain management in children and adults. The guideline was subsequently approved by the American Society for Regional Anesthesia. As part of the guideline development process, a systematic review was commissioned on various aspects related to various interventions and management strategies for postoperative pain. After a review of the evidence, the expert panel formulated recommendations that addressed various aspects of postoperative pain management, including preoperative education, perioperative pain management planning, use of different pharmacological and nonpharmacological modalities, organizational policies, and transition to outpatient care. The recommendations are based on the underlying premise that optimal management begins in the preoperative period with an assessment of the patient and development of a plan of care tailored to the individual and the surgical procedure involved. The panel found that evidence supports the use of multimodal regimens in many situations, although the exact components of effective multimodal care will vary depending on the patient, setting, and surgical procedure. Although these guidelines are based on a systematic review of the evidence on management of postoperative pain, the panel identified numerous research gaps. Of 32 recommendations, 4 were assessed as being supported by high-quality evidence, and 11 (in the areas of patient education and perioperative planning, patient assessment, organizational structures and policies, and transitioning to outpatient care) were made on the basis of low-quality evidence.
  
  
  CONCLUSIONS
  This guideline, on the basis of a systematic review of the evidence on postoperative pain management, provides recommendations developed by a multidisciplinary expert panel. Safe and effective postoperative pain management should be on the basis of a plan of care tailored to the individual and the surgical procedure involved, and multimodal regimens are recommended in many situations.
authors.affiliation: Departments of Medicine, and Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Pacific Northwest Evidence Based Practice Center, Portland, Oregon. Electronic address: chour@ohsu.edu.
authors.forename: Roger
authors.initials: R
authors.lastname: Chou
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
authors.forename: Debra B
authors.initials: DB
authors.lastname: Gordon
authors.affiliation: Department of Anesthesiology and Pain Medicine, Roswell Park Cancer Institute and University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York.
authors.forename: Oscar A
authors.initials: OA
authors.lastname: de Leon-Casasola
authors.affiliation: Veterans Integrated Service Network, Department of Veterans Affairs and Departments of Physical Medicine and Rehabilitation and Anesthesiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jack M
authors.initials: JM
authors.lastname: Rosenberg
authors.affiliation: Pediatric Surgery, University of California, San Diego, San Diego, California.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bickler
authors.affiliation: Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Tim
authors.initials: T
authors.lastname: Brennan
authors.affiliation: Department of Anesthesia, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Todd
authors.initials: T
authors.lastname: Carter
authors.affiliation: Department of Veterans Affairs, Veterans Health Administration, Washington, DC.
authors.forename: Carla L
authors.initials: CL
authors.lastname: Cassidy
authors.affiliation: Department of Palliative Care, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Eva Hall
authors.initials: EH
authors.lastname: Chittenden
authors.affiliation: Quality Management Division, United States Army Medical Command, San Antonio, Texas.
authors.forename: Ernest
authors.initials: E
authors.lastname: Degenhardt
authors.affiliation: Critical Care Medicine, Walter Reed Army Medical Center, Bethesda, Maryland.
authors.forename: Scott
authors.initials: S
authors.lastname: Griffith
authors.affiliation: Department of Pediatrics, University of Connecticut School of Medicine, Mansfield, Connecticut.
authors.forename: Renee
authors.initials: R
authors.lastname: Manworren
authors.affiliation: American Academy of Pain Medicine, San Diego, California.
authors.forename: Bill
authors.initials: B
authors.lastname: McCarberg
authors.affiliation: Department of Anesthesiology, University of Colorado, Denver, Denver, Colorado.
authors.forename: Robert
authors.initials: R
authors.lastname: Montgomery
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jamie
authors.initials: J
authors.lastname: Murphy
authors.affiliation: Department of Surgery, Veterans Affairs Medical Center, West Haven, Connecticut.
authors.forename: Melissa F
authors.initials: MF
authors.lastname: Perkal
authors.affiliation: Department of Pediatric Anesthesia, Children's Hospital of Chicago, Chicago, Illinois.
authors.forename: Santhanam
authors.initials: S
authors.lastname: Suresh
authors.affiliation: Department of Physical Therapy and Rehabilitation, University of Iowa, Iowa City, Iowa.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Sluka
authors.affiliation: College of Pharmacy, University of Texas at Austin, Austin, Texas.
authors.forename: Scott
authors.initials: S
authors.lastname: Strassels
authors.affiliation: Bariatric Weight Loss Surgery Center, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Richard
authors.initials: R
authors.lastname: Thirlby
authors.affiliation: Department of Anesthesiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Eugene
authors.initials: E
authors.lastname: Viscusi
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Walco
authors.affiliation: Department of Veteran Affairs, Phoenix, Arizona.
authors.forename: Lisa
authors.initials: L
authors.lastname: Warner
authors.affiliation: Department of Anesthesiology, Children's Hospital of Wisconsin, Wauwatosa, Wisconsin.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Weisman
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wu
mesh_terms: D006801:Humans; D059408:Pain Management / Q000592:standards*; D010149:Postoperative Pain / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012955:Societies, Medical / Q000592:standards*
keywords: Postoperative pain management; analgesia; clinical practice guidelines; education; multimodal therapy; neuraxial analgesia; patient assessment; regional analgesia