Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1029_Библиотеки_им_академика_М_И_Перельмана

Multimodal analgesia is successful because it targets different pain signaling molecules or directly affects receptors involved in the pain pathway. It is best clinical practice to use a multi­modal approach to manage patients’ pain during their hospital course [22]. A multimodal approach can be implemented preoperatively, intraopera­tively, and postoperatively. Preoperatively treat­ing patients with analgesic medications to reduce postoperative pain is known as preemptive anal­gesia and has become part of multimodal pain pathways that have been applied to many types of surgeries, including head and neck cancer sur­gery [23]. Preoperatively, patients can be admin­istered oral or intravenous medications. Preemptive analgesia has been shown to delay time to the rst analgesic request and reduce total analgesic use [24]. Timing of administration has not been shown to make a signicant difference in effect, thus giving preemptive analgesics immediately before surgery is acceptable. The most frequently used preemptive analgesics are acetaminophen and gabapentin [22]. Multimodal analgesia reduces opioid use intraoperatively and in the postanesthesia care unit (PACU) when patients are administered preoperative oral cele­coxib, gabapentin, and/or tramadol [25]. A large systematic review study showed that gabapenti­noids were the most commonly used non-opioid (72.9%) followed by nonsteroidal anti­inammatory drugs (NSAIDs) (44.6%), acet­aminophen (44.3%), corticosteroids (25.1%), ketamine (7.2%), and nerve block (3.4%) [22]. The use of multimodal analgesia is associated with signicant reductions in opioid use and con­comitantly decreases opioid-related adverse events (ORAEs) [26]. Patients who receive mul­timodal analgesia have lower pain scores in the postoperative period (POD 0–6) compared to opioid-only counterparts [20]. Of the multimodal analgesic regimens studied, none have demon­strated increased incidence of postoperative