APS Guideline for Postoperative Pain

Management of Postoperative Pain: A Clinical Practice Guideline | Journal of Pain | Feb 2016

Here’s another opioid guideline, this time for after surgery, released only a month before the CDC guidelines and it seems similar in its focus on less effective pain management methods instead of opioids, including NSAIDs, acetaminophen, anti-epileptics (Lyrica).

However, the guidelines do recommend ketamine and lidocaine infusions.

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.

Opioids have been the standby for decades. If postoperative opioids were really so addicting, all Americans who ever had surgery would be addicted, yet this has not even come close to happening.

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.

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.

In no other field of medicine would decisions be made “on the basis of low-quality evidence”. In fact, one of the rallying cries of the anti-opioid brigade is that there is no evidence opioids are effective long term.

In this case, vague and unreliable evidence is considered “no evidence” whereas, for opioid-restricting policies, the same kind of vague evidence is considered valid and sufficient to establish guidelines to be followed by all medical professionals in the country.

Below is an image of the outline (links not functional) so you can see how they have organized their recommendations. (This outline is at the top of the article)

PostOp Pain Tx

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