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Multimodal Analgesia

  • Archana O’Neill
    Affiliations
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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  • Philipp Lirk
    Correspondence
    Corresponding author. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115.
    Affiliations
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
    Search for articles by this author

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      References

        • Gerbershagen H.J.
        • Aduckathil S.
        • van Wijck A.J.
        • et al.
        Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures.
        Anesthesiology. 2013; 118: 934-944
        • Sardana V.
        • Burzynski J.M.
        • Scuderi G.R.
        Adductor canal block or local infiltrate analgesia for pain control after total knee arthroplasty? A systematic review and meta-analysis of randomized controlled trials.
        J Arthroplasty. 2019; 34: 183-189
        • Pitchon D.N.
        • Dayan A.C.
        • Schwenk E.S.
        • et al.
        Updates on multimodal analgesia for orthopedic surgery.
        Anesthesiol Clin. 2018; 36: 361-373
        • Kharasch E.D.
        • Avram M.J.
        • Clark J.D.
        Rational perioperative opioid management in the era of the opioid crisis: reply.
        Anesthesiology. 2020; 133: 942-943
        • Levy N.
        • Sturgess J.
        • Mills P.
        Pain as the fifth vital sign" and dependence on the "numerical pain scale" is being abandoned in the US: Why?.
        Br J Anaesth. 2018; 120: 435-438
        • Wu C.L.
        • Raja S.N.
        Treatment of acute postoperative pain.
        Lancet. 2011; 377: 2215-2225
        • Lirk P.
        • Rathmell J.P.
        Opioid-free anaesthesia: Con: it is too early to adopt opioid-free anaesthesia today.
        Eur J Anaesthesiol. 2019; 36: 250-254
        • Correll D.J.
        • Vlassakov K.V.
        • Kissin I.
        No evidence of real progress in treatment of acute pain, 1993-2012: scientometric analysis.
        J Pain Res. 2014; 7: 199-210
        • Meissner W.
        • Zaslansky R.
        A survey of postoperative pain treatments and unmet needs.
        Best Pract Res Clin Anaesthesiol. 2019; 33: 269-286
        • Gan T.J.
        • Habib A.S.
        • Miller T.E.
        • et al.
        Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey.
        Curr Med Res Opin. 2014; 30: 149-160
        • Joshi G.P.
        • Kehlet H.
        • Group P.W.
        Guidelines for perioperative pain management: need for re-evaluation.
        Br J Anaesth. 2017; 119: 703-706
        • Schreiber K.L.
        • Zinboonyahgoon N.
        • Xu X.
        • et al.
        Preoperative Psychosocial and Psychophysical Phenotypes as Predictors of Acute Pain Outcomes After Breast Surgery.
        J Pain. 2018; 20: 540-556
        • Ladha K.S.
        • Patorno E.
        • Huybrechts K.F.
        • et al.
        Variations in the use of perioperative multimodal analgesic therapy.
        Anesthesiology. 2016; 124: 837-845
        • Manworren R.C.
        Multimodal pain management and the future of a personalized medicine approach to pain.
        AORN J. 2015; 101: 308-314
        • Buvanendran A.
        • Kroin J.S.
        Multimodal analgesia for controlling acute postoperative pain.
        Curr Opin Anaesthesiol. 2009; 22: 588-593
        • Kehlet H.
        • Dahl J.B.
        The value of "multimodal" or "balanced analgesia" in postoperative pain treatment.
        Anesth Analg. 1993; 77: 1048-1056
        • Buvanendran A.
        • Kroin J.S.
        Useful adjuvants for postoperative pain management.
        Best Pract Res Clin Anaesthesiol. 2007; 21: 31-49
        • American Society of Anesthesiologists Task Force on Acute Pain M
        Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management.
        Anesthesiology. 2012; 116: 248-273
        • Chou R.
        • Gordon D.B.
        • de Leon-Casasola O.A.
        • et al.
        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.
        J Pain. 2016; 17: 131-157
        • Halawi M.J.
        • Grant S.A.
        • Bolognesi M.P.
        Multimodal Analgesia for Total Joint Arthroplasty.
        Orthopedics. 2015; 38: e616-e625
        • Joshi G.P.
        • Kehlet H.
        Enhanced Recovery Pathways: Looking Into the Future.
        Anesth Analg. 2019; 128: 5-7
        • Frassanito L.
        • Vergari A.
        • Nestorini R.
        • et al.
        Enhanced recovery after surgery (ERAS) in hip and knee replacement surgery: description of a multidisciplinary program to improve management of the patients undergoing major orthopedic surgery.
        Musculoskelet Surg. 2020; 104: 87-92
        • Oscier C.D.
        • Milner Q.J.
        Peri-operative use of paracetamol.
        Anaesthesia. 2009; 64: 65-72
        • Klinger-Gratz P.P.
        • Ralvenius W.T.
        • Neumann E.
        • et al.
        Acetaminophen relieves inflammatory pain through cb1 cannabinoid receptors in the rostral ventromedial medulla.
        J Neurosci. 2018; 38: 322-334
        • Mattia C.
        • Coluzzi F.
        What anesthesiologists should know about paracetamol (acetaminophen).
        Minerva Anestesiol. 2009; 75: 644-653
        • Remy C.
        • Marret E.
        • Bonnet F.
        Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials.
        Br J Anaesth. 2005; 94: 505-513
        • Toms L.
        • McQuay H.J.
        • Derry S.
        • et al.
        Single dose oral paracetamol (acetaminophen) for postoperative pain in adults.
        Cochrane Database Syst Rev. 2008; : CD004602
        • Martinez V.
        • Beloeil H.
        • Marret E.
        • et al.
        Non-opioid analgesics in adults after major surgery: systematic review with network meta-analysis of randomized trials.
        Br J Anaesth. 2017; 118: 22-31
        • Ong C.K.
        • Seymour R.A.
        • Lirk P.
        • et al.
        Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain.
        Anesth Analg. 2010; 110: 1170-1179
        • Joshi G.P.
        • Van de Velde M.
        • Kehlet H.
        • et al.
        Development of evidence-based recommendations for procedure-specific pain management: PROSPECT methodology.
        Anaesthesia. 2019; 74: 1298-1304
        • Thybo K.H.
        • Hagi-Pedersen D.
        • Dahl J.B.
        • et al.
        Effect of combination of paracetamol (acetaminophen) and ibuprofen vs either alone on patient-controlled morphine consumption in the first 24 hours after total hip arthroplasty: the PANSAID Randomized Clinical Trial.
        JAMA. 2019; 321: 562-571
        • Candido K.D.
        • Perozo O.J.
        • Knezevic N.N.
        Pharmacology of acetaminophen, nonsteroidal antiinflammatory drugs, and steroid medications: implications for anesthesia or unique associated risks.
        Anesthesiol Clin. 2017; 35: e145-e162
        • Marret E.
        • Kurdi O.
        • Zufferey P.
        • et al.
        Effects of nonsteroidal antiinflammatory drugs on patient-controlled analgesia morphine side effects: meta-analysis of randomized controlled trials.
        Anesthesiology. 2005; 102: 1249-1260
        • Fillingham Y.A.
        • Hannon C.P.
        • Roberts K.C.
        • et al.
        The efficacy and safety of nonsteroidal anti-inflammatory drugs in total joint arthroplasty: systematic review and direct meta-analysis.
        J Arthroplasty. 2020; 35: 2739-2758
        • Hsu J.R.
        • Mir H.
        • Wally M.K.
        • et al.
        Orthopaedic trauma association musculoskeletal pain task F. clinical practice guidelines for pain management in acute musculoskeletal injury.
        J Orthop Trauma. 2019; 33: e158-e182
        • Gan T.J.
        • Belani K.G.
        • Bergese S.
        • et al.
        Fourth consensus guidelines for the management of postoperative nausea and vomiting.
        Anesth Analg. 2020; 131: 411-448
        • Rhen T.
        • Cidlowski J.A.
        Antiinflammatory action of glucocorticoids--new mechanisms for old drugs.
        N Engl J Med. 2005; 353: 1711-1723
        • Sharma M.
        • Gupta S.
        • Purohit S.
        • et al.
        The effect of intravenous dexamethasone on intraoperative and early postoperative pain in lumbar spine surgery: a randomized double-blind placebo-controlled study.
        Anesth Essays Res. 2018; 12: 803-808
        • De Oliveira Jr., G.S.
        • Almeida M.D.
        • Benzon H.T.
        • et al.
        Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials.
        Anesthesiology. 2011; 115: 575-588
        • Waldron N.H.
        • Jones C.A.
        • Gan T.J.
        • et al.
        Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis.
        Br J Anaesth. 2013; 110: 191-200
        • Heesen M.
        • Rijs K.
        • Hilber N.
        • et al.
        Effect of intravenous dexamethasone on postoperative pain after spinal anaesthesia - a systematic review with meta-analysis and trial sequential analysis.
        Anaesthesia. 2019; 74: 1047-1056
        • Herbst R.A.
        • Telford O.T.
        • Hunting J.
        • et al.
        The effects of perioperative dexamethasone on glycemic control and postoperative outcomes.
        Endocr Pract. 2020; 26: 218-225
        • Tiippana E.M.
        • Hamunen K.
        • Kontinen V.K.
        • et al.
        Do surgical patients benefit from perioperative gabapentin/pregabalin? A systematic review of efficacy and safety.
        Anesth Analg. 2007; 104: 1545-1556
        • Doleman B.
        • Heinink T.P.
        • Read D.J.
        • et al.
        A systematic review and meta-regression analysis of prophylactic gabapentin for postoperative pain.
        Anaesthesia. 2015; 70: 1186-1204
        • Arumugam S.
        • Lau C.S.
        • Chamberlain R.S.
        Use of preoperative gabapentin significantly reduces postoperative opioid consumption: a meta-analysis.
        J Pain Res. 2016; 9: 631-640
        • Savelloni J.
        • Gunter H.
        • Lee K.C.
        • et al.
        Risk of respiratory depression with opioids and concomitant gabapentinoids.
        J Pain Res. 2017; 10: 2635-2641
        • Fabritius M.L.
        • Geisler A.
        • Petersen P.L.
        • et al.
        Gabapentin for post-operative pain management - a systematic review with meta-analyses and trial sequential analyses.
        Acta Anaesthesiol Scand. 2016; 60: 1188-1208
        • Kharasch E.D.
        • Clark J.D.
        • Kheterpal S.
        Perioperative gabapentinoids: deflating the bubble.
        Anesthesiology. 2020; 133: 251-254
        • Hah J.
        • Mackey S.C.
        • Schmidt P.
        • et al.
        Effect of perioperative gabapentin on postoperative pain resolution and opioid cessation in a mixed surgical cohort: a randomized clinical trial.
        JAMA Surg. 2018; 153: 303-311
        • Woolf C.J.
        • Thompson S.W.
        The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states.
        Pain. 1991; 44: 293-299
        • Mion G.
        • Villevieille T.
        Ketamine pharmacology: an update (pharmacodynamics and molecular aspects, recent findings).
        CNS Neurosci Ther. 2013; 19: 370-380
        • Schwenk E.S.
        • Viscusi E.R.
        • Buvanendran A.
        • et al.
        Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists.
        Reg Anesth Pain Med. 2018; 43: 456-466
        • Zeballos J.L.
        • Lirk P.
        • Rathmell J.P.
        Low-Dose Ketamine for Acute Pain Management: A Timely Nudge Toward Multimodal Analgesia.
        Reg Anesth Pain Med. 2018; 43: 453-455
        • Laskowski K.
        • Stirling A.
        • McKay W.P.
        • et al.
        A systematic review of intravenous ketamine for postoperative analgesia.
        Can J Anaesth. 2011; 58: 911-923
        • Loftus R.W.
        • Yeager M.P.
        • Clark J.A.
        • et al.
        Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery.
        Anesthesiology. 2010; 113: 639-646
        • Boenigk K.
        • Echevarria G.C.
        • Nisimov E.
        • et al.
        Low-dose ketamine infusion reduces postoperative hydromorphone requirements in opioid-tolerant patients following spinal fusion: a randomised controlled trial.
        Eur J Anaesthesiol. 2019; 36: 8-15
        • Sharma S.
        • Balireddy R.K.
        • Vorenkamp K.E.
        • et al.
        Beyond opioid patient-controlled analgesia: a systematic review of analgesia after major spine surgery.
        Reg Anesth Pain Med. 2012; 37: 79-98
        • Avidan M.S.
        • Maybrier H.R.
        • Abdallah A.B.
        • et al.
        Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults: an international, multicentre, double-blind, randomised clinical trial.
        Lancet. 2017; 390: 267-275
        • McNicol E.D.
        • Schumann R.
        • Haroutounian S.
        A systematic review and meta-analysis of ketamine for the prevention of persistent post-surgical pain.
        Acta Anaesthesiol Scand. 2014; 58: 1199-1213
        • Tramer M.R.
        • Schneider J.
        • Marti R.A.
        • et al.
        Role of magnesium sulfate in postoperative analgesia.
        Anesthesiology. 1996; 84: 340-347
        • De Oliveira Jr., G.S.
        • Castro-Alves L.J.
        • Khan J.H.
        • et al.
        Perioperative systemic magnesium to minimize postoperative pain: a meta-analysis of randomized controlled trials.
        Anesthesiology. 2013; 119: 178-190
        • Albrecht E.
        • Kirkham K.R.
        • Liu S.S.
        • et al.
        Peri-operative intravenous administration of magnesium sulphate and postoperative pain: a meta-analysis.
        Anaesthesia. 2013; 68: 79-90
        • Murphy J.D.
        • Paskaradevan J.
        • Eisler L.L.
        • et al.
        Analgesic efficacy of continuous intravenous magnesium infusion as an adjuvant to morphine for postoperative analgesia: a systematic review and meta-analysis.
        Middle East J Anaesthesiol. 2013; 22: 11-20
        • Guo B.L.
        • Lin Y.
        • Hu W.
        • et al.
        Effects of Systemic Magnesium on Post-operative Analgesia: Is the Current Evidence Strong Enough?.
        Pain Physician. 2015; 18: 405-418
        • Rodriguez-Rubio L.
        • Nava E.
        • Del Pozo J.S.G.
        • et al.
        Influence of the perioperative administration of magnesium sulfate on the total dose of anesthetics during general anesthesia. A systematic review and meta-analysis.
        J Clin Anesth. 2017; 39: 129-138
        • Bujalska-Zadrozny M.
        • Tatarkiewicz J.
        • Kulik K.
        • et al.
        Magnesium enhances opioid-induced analgesia - what we have learnt in the past decades?.
        Eur J Pharm Sci. 2017; 99: 113-127
        • Blaudszun G.
        • Lysakowski C.
        • Elia N.
        • et al.
        Effect of perioperative systemic alpha2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials.
        Anesthesiology. 2012; 116: 1312-1322
        • Nguyen V.
        • Tiemann D.
        • Park E.
        • et al.
        Alpha-2 Agonists.
        Anesthesiol Clin. 2017; 35: 233-245
        • Devereaux P.J.
        • Sessler D.I.
        • Leslie K.
        • et al.
        Clonidine in patients undergoing noncardiac surgery.
        N Engl J Med. 2014; 370: 1504-1513
        • Ungur A.L.
        • Neumann T.
        • Borchers F.
        • et al.
        Perioperative management of alcohol withdrawal syndrome.
        Visc Med. 2020; 36: 160-166
        • Hidalgo M.P.
        • Auzani J.A.
        • Rumpel L.C.
        • et al.
        The clinical effect of small oral clonidine doses on perioperative outcomes in patients undergoing abdominal hysterectomy.
        Anesth Analg. 2005; 100: 795-802
        • Lewis S.R.
        • Nicholson A.
        • Smith A.F.
        • et al.
        Alpha-2 adrenergic agonists for the prevention of shivering following general anaesthesia.
        Cochrane Database Syst Rev. 2015; 8: CD011107
        • Schnabel A.
        • Meyer-Friessem C.H.
        • Reichl S.U.
        • et al.
        Is intraoperative dexmedetomidine a new option for postoperative pain treatment? A meta-analysis of randomized controlled trials.
        Pain. 2013; 154: 1140-1149
        • Le Bot A.
        • Michelet D.
        • Hilly J.
        • et al.
        Efficacy of intraoperative dexmedetomidine compared with placebo for surgery in adults: a meta-analysis of published studies.
        Minerva Anestesiol. 2015; 81: 1105-1117
        • Liu Y.
        • Liang F.
        • Liu X.
        • et al.
        Dexmedetomidine Reduces Perioperative Opioid Consumption and Postoperative Pain Intensity in Neurosurgery: A Meta-analysis.
        J Neurosurg Anesthesiol. 2018; 30: 146-155
        • Tsaousi G.G.
        • Pourzitaki C.
        • Aloisio S.
        • et al.
        Dexmedetomidine as a sedative and analgesic adjuvant in spine surgery: a systematic review and meta-analysis of randomized controlled trials.
        Eur J Clin Pharmacol. 2018; 74: 1377-1389
        • Singh P.M.
        • Panwar R.
        • Borle A.
        • et al.
        Perioperative analgesic profile of dexmedetomidine infusions in morbidly obese undergoing bariatric surgery: a meta-analysis and trial sequential analysis.
        Surg Obes Relat Dis. 2017; 13: 1434-1446
        • Calderon P.
        • Deltenre P.
        • Stany I.
        • et al.
        Clonidine administration during intraoperative monitoring for pediatric scoliosis surgery: Effects on central and peripheral motor responses.
        Neurophysiol Clin. 2018; 48: 93-102
        • Kaye A.D.
        • Chernobylsky D.J.
        • Thakur P.
        • et al.
        Dexmedetomidine in enhanced recovery after surgery (ERAS) protocols for postoperative pain.
        Curr Pain Headache Rep. 2020; 24: 21
        • Kerr D.R.
        • Kohan L.
        Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients.
        Acta Orthop. 2008; 79: 174-183
        • Zhao Y.
        • Huang Z.
        • Ma W.
        Comparison of adductor canal block with local infiltration analgesia in primary total knee arthroplasty: a meta-analysis of randomized controlled trials.
        Int J Surg. 2019; 69: 89-97
        • Anger M.
        • Valovska T.
        • Beloeil H.
        • et al.
        PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations.
        Anaesthesia. 2021; 76: 1082-1097
        • Li J.W.
        • Ma Y.S.
        • Xiao L.K.
        Postoperative Pain Management in Total Knee Arthroplasty.
        Orthop Surg. 2019; 11: 755-761
        • Andersen L.O.
        • Kehlet H.
        Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic review.
        Br J Anaesth. 2014; 113: 360-374
        • Terkawi A.S.
        • Mavridis D.
        • Sessler D.I.
        • et al.
        Pain management modalities after total knee arthroplasty: a network meta-analysis of 170 randomized controlled trials.
        Anesthesiology. 2017; 126: 923-937
        • Ilfeld B.M.
        • Duke K.B.
        • Donohue M.C.
        The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty.
        Anesth Analg. 2010; 111: 1552-1554
        • Jaeger P.
        • Koscielniak-Nielsen Z.J.
        • Hilsted K.L.
        • et al.
        Adductor Canal Block With 10 mL Versus 30 mL Local Anesthetics and Quadriceps Strength: A Paired, Blinded, Randomized Study in Healthy Volunteers.
        Reg Anesth Pain Med. 2015; 40: 553-558
        • Jaeger P.
        • Nielsen Z.J.
        • Henningsen M.H.
        • et al.
        Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers.
        Anesthesiology. 2013; 118: 409-415
        • Jaeger P.
        • Zaric D.
        • Fomsgaard J.S.
        • et al.
        Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study.
        Reg Anesth Pain Med. 2013; 38: 526-532
        • Chen J.
        • Zhou C.
        • Ma C.
        • et al.
        Which is the best analgesia treatment for total knee arthroplasty: Adductor canal block, periarticular infiltration, or liposomal bupivacaine? A network meta-analysis.
        J Clin Anesth. 2021; 68: 110098