Practical issues in postoperative pain management: pain assessment and personalized choice of analgesics (review)

This review focuses on the critical aspects of rational postoperative pain management in surgical hospitals, emphasizing a multimodal, opioid-sparing approach. We discuss the principles of evidence-based analgesia, including the importance of using validated pain scales for consistent pain assessment and defining pain thresholds for initiating and modifying analgesic therapies. Defining target pain levels is crucial for guiding therapeutic interventions and achieving optimal pain relief. This paper describes a systematic and multi-modal approach to analgesic selection, emphasizing the combination of non-opioid analgesics like paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) with opioid analgesics, regional analgesia, and non-pharmacological interventions. Continuous evaluation of pain levels and response to therapy is essential for ensuring effective pain control and minimizing the risk of complications. The review highlights the potential benefits of preoperative analgesia in reducing opioid requirements and the incidence of chronic neuropathic pain. We discuss the unique challenges of pain management in children, emphasizing the need for age-appropriate dosing and administration routes, taking into account the physiological differences between adults and children. The review emphasizes the crucial role of individualizing pain management strategies based on patient characteristics including age, co-morbidities, drug tolerance, and genetic factors. We discuss the impact of genetic polymorphisms in CYP2C9 and CYP2D6 enzymes on NSAID and opioid metabolism in relation to optimizing both efficacy and safety. This review provides a comprehensive overview of the principles and practices for rational postoperative pain management, aiming to improve pain control, reduce opioid use, minimize adverse drug reactions, and enhance patient satisfaction and quality of life following surgical interventions. Implementing standardized pain assessment tools and protocols, utilizing a multi-modal analgesic approach, emphasizing preventive analgesia strategies, considering genetic factors in individual treatment plans, and prioritizing patient education and shared decision-making are key recommendations for healthcare professionals involved in the postoperative management of surgical patients. By adopting these evidence-based recommendations, we can strive to deliver optimal pain relief and enhance the overall recovery experience for patients.