Abstract

ESTEVE-PEREZ, N. et al. New approaches in the treatment of acute postoperative pain. Rev. Soc. Esp. Dolor [online]. 2017, vol.24, n.3, pp.132-139. ISSN 1134-8046.  https://dx.doi.org/10.20986/resed.2017.3542/2016.

Effective control of postoperative pain, as well as other factors such as early mobilization and nutrition, are directly related to the reduction of postoperative complications and hospital stay, and have become an essential part of perioperative care There are actually several challenges in the field of the treatment of DAP, which require new approaches and therapeutic alternatives.

The specific analgesic protocols for each type of surgery, adapted to the organizational context and clinical practice, are a guarantee to individualize the treatments and appropriately respond to the analgesic demands of any patient.

Among the recommendations of the recent Guidelines for the Management of Acute Postoperative Pain of the American Pain Society (APS), we highlight: the use of Multimodal Analgesia, Regional and Epidural Analgesia in specific procedures, the minimum possible doses of opioids, the preference of the oral versus intravenous route, and PCA modality.

Faced with the epidemic use of opioids, the current recommendations are based on minimizing the dose of postoperative opioids, together with, applying multimodal guidelines and early withdrawing, when they can be replaced by other analgesics.

In fast-track surgery programs, the early onset of ambulation, physical therapy and/or rehabilitation are feasible with a moderate level of pain. Attempting to eliminate completely the pain in these fast-track programs can be associated with patients immobility, or analgesic side effects that may delay patients recovery.

New devices for administering non-invasive opioids or "needel-free" have been developed in order to eliminate the disadvantages of intravenous morphine. The theoretical advantages are based on greater mobility and patient satisfaction, self-administration and a better pharmacological profile. They are fast onset opioids with a prolonged action and without active metabolites, which offer a theoretically more effective and safe pharmacological profile. These new alternatives could replace the administration of morphine PCA to boluses, in major laparoscopic surgery or in spinal surgery, among others. They may also play a role in the transition analgesia, in situations such as early withdrawal of epidural or paravertebral catheters in thoracic or vascular surgery.

Keywords : Postoperative pain prevalence; management of postoperative pain; epidemic opioids; fast-track surgery; sublingual sufentanil; fentanyl iontophoretic transdermal system.

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