Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20230075-en
Brazilian Journal of Pain
Review Article

Use of multimodal anesthesia in the treatment of postoperative pain

Uso da anestesia multimodal no tratamento da dor pós-operatória

Thaíza Paula Martins; Danila Malheiros Souza; Daiane Malheiros Souza

Downloads: 0
Views: 98

Abstract

BACKGROUND AND OBJECTIVES: Hippocrates already said 2400 years ago: “relieving pain is a divine work”. Postoperative pain is an important symptom, because it affects the patient’s recovery and because of the risk of pain chronicity. And as a treatment option, there is multimodal analgesia, mentioned in several studies as the best approach, although opioid therapy is still the main treatment for pain after surgical interventions. The objective of this study was to describe the use of multimodal anesthesia in the treatment of pain, especially in the postoperative period.
CONTENTS: A literature review was performed on studies that explained multimodal analgesia, its components, and which analyzed therapeutic drug options. The theme was approached from a consultation of articles published in LILACS, Scielo, Medline and Pubmed, in English and Portuguese, between the years 2012 and 2022. The keywords used for research were: “multimodal analgesia”, “multimodal anesthesia”, “surgical procedures” “postoperative”. In the results, examples of drugs that are part of multimodal analgesia in different procedures were listed.
CONCLUSION: In this way, multimodal anesthesia has demonstrated its benefits for the treatment of postoperative pain in various surgical procedures. However, further studies are needed so that this modality can be used more widely.

Keywords

Multimodal anesthesia, Pain, Postoperative, Treatment

Resumo

JUSTIFICATIVA E OBJETIVOS: Hipócrates já dizia há 2400 anos: “aliviar a dor é uma obra divina”. A dor pós-operatória é um sintoma importante por causar repercussões na recuperação do paciente e devido ao risco de cronicidade da dor. Como opção de tratamento, tem-se a analgesia multimodal, sendo mencionada em diversos estudos como a melhor conduta, embora a terapia com opioides ainda seja o principal tratamento para a dor após intervenções cirúrgicas. O objetivo deste estudo foi descrever o uso da anestesia multimodal no tratamento da dor, em especial no pós-operatório. 
CONTEÚDO: Foi realizada uma revisão de literatura sobre estudos que explicitaram a analgesia multimodal e seus componentes, ou que analisaram opções terapêuticas de fármacos. O tema foi abordado a partir de uma consulta de artigos publicados nas bases LILACS, Scielo, Medline e Pubmed, na língua inglesa e em português, entre os anos de 2012 e 2022. As palavras-chaves utilizadas para pesquisa foram: “multimodal analgesia”, “multimodal anesthesia”, “surgical procedures” e “postoperative”. Nos resultados, foram listados exemplos de fármacos que fazem parte da analgesia multimodal em diferentes procedimentos. 
CONCLUSÃO: Nesse sentido, a anestesia multimodal demonstrou seus benefícios para o tratamento da dor no pós-operatório em vários procedimentos cirúrgicos. Contudo, são necessários novos estudos a fim de que esta modalidade seja utilizada de forma mais abrangente. 

Palavras-chave

Anestesia multimodal, Dor, Pós-operatório, Tratamento

References

1 Bertoncello KCG, Xavier LB, Nascimento ERP, Amante LN. Dor aguda na emergência: avaliação e controle com o instrumento de MacCaffery e Beebe. J Health Sci. 2016;18(4):251-6.

2 Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618-25.

3 Safari S, Rokhtabnak F, Djalali Motlagh S, Ghanbari Garkani M, Pournajafian A. Effect of intraperitoneal bupivacaine on postoperative pain in laparoscopic bariatric surgeries. Surg Obes Relat Dis. 2020;16(2):299-305.

4 Gan, TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10:2287-98.

5 Manworren RC. Multimodal pain management and the future of a personalized medicine approach to pain. AORN J. 2015;101(3):308-18.

6 Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, Carter T, Cassidy CL, Chittenden EH, Degenhardt E, Griffith S, Manworren R, Mc-Carberg B, Montgomery R, Murphy J, Perkal MF, Suresh S, Sluka K, Strassels S, Thirlby R, Viscusi E, Walco GA, Warner L, Weisman SJ, Wu CL. 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(2):131-57.

7 Volkow ND, Jones EB, Einstein EB, Wargo EM. Prevention and treatment of opioid misuse and addiction: a review. JAMA Psychiatry. 2019;76(2):208-6.

8 Wick EC, Grant MC, Wu CL. Manejo da dor pós-operatória multimodal analgesia com analgésicos não opióides e técnicas. Uma revisão. Cirurgia JAMA2017;152(7):691-7.

9 Beloeil H. Opioid-free anesthesia. Best Pract Res Clin Anaesthesiol. 2019;33(3):353-60.

10 Rodrigues LG, Palotti A. Anestesia multimodal em pacientes submetidos à cirurgia bariátrica (gastroplastia por bypass gástrico): relato de experiência. Braz J Health Rev. 2022;5(1):507-17.

11 Beverly A, Kaye AD, Ljungqvist O, Urman RD. Essential elements of multimodal analgesia in enhanced recovery after surgery (ERAS) guidelines. Anesthesiol Clin. 2017;35(2):e115-e143.

12 Brown EN, Pavone KJ, Naranjo M. Multimodal general anesthesia: theory and practice. Anesth Analg. 2018;127(5):1246-58.

13 Toleska M, Dimitrovski A, Shosholcheva M, Kartalov A, Kuzmanovska B, Dimitrovska NT. Pain and multimodal analgesia in laparoscopic cholecystectomy. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2022;43(2):41-9.

14 Schoenbrunner AR, Joshi GP, Janis JE. Multimodal analgesia in the aesthetic plastic surgery: concepts and strategies. Plast Reconstr Surg Glob Open. 2022;10(5):e4310.

15 Dong W, An B, Wang Y, Cui X, Gan J. Effect of multimodal analgesia on gynecological cancer patients after radical resection. Am J Transl Res. 2021;13(4):2686-93.

16 De Jong R, Shysh AJ. Development of a multimodal analgesia protocol for perioperative acute pain management for lower limb amputation. Pain Res Manag. 2018;20:5237040.

17 Forkin KT, Mitchell RD, Chiao SS, Song C, Chronister BNC, Wang XQ, Chisholm CA, Tiouririne M. Impact of timing of multimodal analgesia in enhanced recovery after cesarean delivery protocols on postoperative opioids: a single center before-and-after study. J Clin Anesth. 2022;80:110847.

18 Singer KE, Philpott CD, Bercz AP, Phillips T, Salyer CE, Hanseman D, Droege ME, Goodman MD, Makley AT. Impact of a multimodal analgesia protocol on inpatient and outpatient opioid use in acute trauma. J Surg Res. 2021;268:9-16.
 


Submitted date:
11/06/2022

Accepted date:
10/05/2023

65a6e63aa953957b6c176953 brjp Articles

BrJP

Share this page
Page Sections