Reaching consensus on the key principles of treating perioperative pain was the goal of a recent pain summit hosted by the American Society of Anesthesiologists (ASA) in February. The stakeholder group, representing 14 medical societies, discussed the fundamentals of acute surgical pain management from their various specialities.
“Every surgeon and anesthesiologist wants to be sure their patients’ acute surgical pain is controlled,” said ASA President Beverly K. Philip, M.D., FACA, FASA. “At the recent summit, we learned from each other what progress has been made toward each principle, what challenges or barriers hamper the successful implementation of the principles and what innovations we should embrace as best practices toward optimal acute pain management.”
By the end of the summit, the group had summarized their position into 7 key principles. They include:
1. Conduct a preoperative evaluation including assessment of medical and psychological conditions, concomitant medications, history of chronic pain, substance abuse, and previous postoperative treatment regimens and responses, to guide the perioperative pain management plan.
2. Use a validated pain assessment tool to track responses to postoperative pain treatments and adjust treatment plans accordingly.
3. Offer multimodal analgesia, or the use of a variety of analgesic medications and techniques combined with nonpharmacological interventions, for the treatment of postoperative pain in adults.
4. Provide patient and family-centered, individually tailored education to the patient (and/or responsible caregiver), including information on treatment options for managing postoperative pain, and document the plan and goals for postoperative pain management.
5. Provide education to all patients (adult) and primary caregivers on the pain treatment plan, including proper storage and disposal of opioids and tapering of analgesics after hospital discharge.
6. Adjust the pain management plan based on adequacy of pain relief and presence of adverse events.
7. Have access to consultation with a pain specialist for patients who have inadequately controlled postoperative pain or at high risk of inadequately controlled postoperative pain at their facilities (e.g., opioid-tolerant, history of substance abuse).
The ASA’s own posted guidelines on Acute Pain Management in the Perioperative Setting point to a 2012 article in Anesthesiology, “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.” That document was essentially an update to the “Practice Guidelines for Acute Pain Management in the Perioperative Setting,” adopted by the ASA in 2003 and published in 2004. The 2012 guidelines provided evaluation of new scientific literature and findings from surveys of experts and randomly selected ASA members. However, the recommendations themselves did not change at that time.
These new principles are based on a collaborative approach to acute pain management and will be developed into a guiding resource for clinicians and all members of the surgical care team in 2021.
According to the ASA, representatives from the following organizations participated in the summit.
- American Academy of Orthopaedic Surgeons
- American Academy of Otolaryngology-Head and Neck Surgery
- American Association of Neurological Surgeons
- American Association of Oral and Maxillofacial Surgeons
- American College of Obstetricians and Gynecologists
- American College of Surgeons
- American Hospital Association
- American Medical Association
- American Society of Breast Surgeons
- American Society of Plastic Surgeons
- American Society of Regional Anesthesia and Pain Medicine
- American Urological Association
- Society of Thoracic Surgeons
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