Moving toward optimal post-op pain management

Traveling the Road to Optimal Pain Management
Sunday, 6-7:30 a.m.
Marina Ballroom Salon G, San Diego Marriott Marquis & Marina


Eugene Viscusi, M.D.

A new vision in pain management is sweeping through anesthesiology. More effective pain management before, during and long after surgery can translate directly into improved outcomes, shorter length of stay, reduced costs and improved patient satisfaction.

“The finish line for anesthesiologists is not the PACU,” said Eugene Viscusi, M.D., Professor of Anesthesiology and Director of Acute Pain Management at Thomas Jefferson University. “The finish line is complete recovery from surgery. We have to be players at a bigger table now, show that we are not only enhancing short-term recovery, but that we can directly impact things like chronic pain following surgery, functionality, recovery and quality of life. Multimodal pain management is the best tool we have to achieve those outcomes.”

Dr. Viscusi will be the first speaker at a breakfast session, “Traveling the Road to Optimal Pain Management,” from 6 to 7:30 a.m. Sunday in Marina Ballroom Salon G at the San Diego Marriott Marquis & Marina. The session is sponsored by an educational grant from Hospira.

Traditional anesthesia focuses on intraoperative management, often using opioids for pain control during and after surgery. But opioids are increasingly associated with suboptimal pain control, delayed recovery, increased length of stay, decreased satisfaction and similar perioperative problems.

The most effective solution is multimodal analgesia that focuses on non-opioid agents that target different pain pathways at different stages before, during and after surgery. The goal is to avoid the adverse effects of opioids while providing more effective and reliable pain management by managing multiple pain pathways using multiple agents with multiple targeted mechanisms of action.

There are well-established guidelines for the use of multimodal analgesia as well as new agents and new protocols for more familiar agents. The larger problem is that only a minority of anesthesia practices actually follow multimodal guidelines while many patients continue to suffer the consequences of inadequate pain management and opioid-related adverse events.

“We are going to focus on the concept of multimodal analgesia, new drugs, new pathways and new guidelines,” Dr. Viscusi said. “It is possible to create enhanced recovery pathways by focusing on specific agents used pre-op and post-op as around-the-clock treatment. This plays into our role as anesthesiologists in perioperative medicine and the perioperative surgical home model. It is not just new drugs and protocols. We gain from nonpharmacologic interventions, such as nutritional support and early mobilization. As an anesthesiologist, I should be thinking about how to transition through the recovery process from preoperative to handing off pain management to the primary care provider, who may ultimately manage pain and recovery once the patient is out of the hospital.”

Continuity is key, he added. Who knows the perioperative process better than the anesthesiologist?

Adopting multimodal analgesia is one part of moving into the Perioperative Surgical Home model of care. The profession is moving toward the new model, but progress is uneven. Research has shown both knowledge and practice gaps among anesthesiologists themselves about optimal strategies to treat acute postoperative pain.

“Multimodal is not just a bunch of new drugs, it is exploiting very specific and targeted pain pathways to improve outcomes,” Dr. Viscusi said. “More effective non-opioid pain management is the future of anesthesiology.”

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