Novel concepts of analgesia for post operative pain: Multimodal analgesia

Abstract

The concept of multimodal analgesia was introduced more than a decade ago as a technique to improve analgesia and reduce the incidence of opioid related adverse events. Multimodal analgesia is achieved by combining different analgesics that act by different mechanisms and at different sites in the nervous system resulting in additive or synergistic analgesia with lowered adverse effects of sole administration of individual analgesics. The analgesic benefits of controlling post-operative pain are generally maximised when a multimodal strategy to facilitate the patients convalescence is implemented.

Principles of multimodal strategy include control of post-operative pain to allow early mobilisation, early enteral nutrition, education and attenuation of the perioperative stress response through the use of regional anaesthetic techniques and a combination of analgesic agents(i.e multimodal analgesia). The adaptation of multimodal ( or balanced) analgesic techniques as the standard approach for prevention of pain in the ambulatory setting is one of the keys to improving the recovery process after day care surgery.

An aggressive multimodal perioperative analgesic regimen that provides effective pain relief has minimal side effects, is intrinsically safe and can be managed by the patient and their family members away from a hospital or surgical center. The approach that combines the consideration of peripheral and central treatment of pain possibly in combination with pre-emptive analgesia, may contribute eventually to a post-operative course without pain and one that provides for very early mobilisation and restoration of function with subsequent reduction in post-operative morbidity and hospital stay.