Official reprint from UpToDate®
www.uptodate.com ©2015 UpToDate®

Management of acute perioperative pain

Edward R Mariano, MD, MAS
Section Editor
Ellen WK Rosenquist, MD
Deputy Editor
Marianna Crowley, MD


The goals of perioperative pain management are to relieve suffering, achieve early mobilization after surgery, reduce length of hospital stay, and achieve patient satisfaction. Pain control regimens must take into account medical, psychological, and physical condition; age; level of fear or anxiety; surgical procedure; personal preference; and response to agents given.

This topic will discuss the rationale and therapeutic options for a multimodal approach to control and prevent acute perioperative pain. The management of chronic pain is discussed separately. (See "Evaluation of chronic pain in adults" and "Overview of the treatment of chronic pain".)


Perioperative pain results from inflammation caused by tissue trauma (ie, surgical incision, dissection, burns) or direct nerve injury (ie, nerve transection, stretching, or compression) (figure 1) [1]. The patient senses pain through the afferent pain pathway (figure 2), which is the target of various pharmacologic agents.

Tissue trauma releases local inflammatory mediators that can produce augmented sensitivity to stimuli in the area surrounding an injury (hyperalgesia) or misperception of pain to non-noxious stimuli (allodynia) (figure 3). Other mechanisms contributing to hyperalgesia and allodynia include sensitization of the peripheral pain receptors (primary hyperalgesia) and increased excitability of central nervous system neurons (secondary hyperalgesia) [1-3].

Traditionally, acute perioperative pain management has relied solely on opioid medications to target central mechanisms involved in the perception of pain (figure 4). A better approach uses several agents, each acting at different sites of the pain pathway, and is known as multimodal analgesia. This approach lessens the dependence on a single medication and mechanism.


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2015. | This topic last updated: Apr 30, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2015 UpToDate, Inc.
  1. Kelly DJ, Ahmad M, Brull SJ. Preemptive analgesia I: physiological pathways and pharmacological modalities. Can J Anaesth 2001; 48:1000.
  2. Woolf CJ, Chong MS. Preemptive analgesia--treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993; 77:362.
  3. Suzuki H. Recent topics in the management of pain: development of the concept of preemptive analgesia. Cell Transplant 1995; 4 Suppl 1:S3.
  4. Møiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology 2002; 96:725.
  5. Rosero EB, Joshi GP. Preemptive, preventive, multimodal analgesia: what do they really mean? Plast Reconstr Surg 2014; 134:85S.
  6. Katz J, Clarke H, Seltzer Z. Review article: Preventive analgesia: quo vadimus? Anesth Analg 2011; 113:1242.
  7. Ong CK, Lirk P, Seymour RA, Jenkins BJ. The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg 2005; 100:757.
  8. Ke RW, Portera SG, Bagous W, Lincoln SR. A randomized, double-blinded trial of preemptive analgesia in laparoscopy. Obstet Gynecol 1998; 92:972.
  9. Ghezzi F, Cromi A, Bergamini V, et al. Preemptive port site local anesthesia in gynecologic laparoscopy: a randomized, controlled trial. J Minim Invasive Gynecol 2005; 12:210.
  10. Updike GM, Manolitsas TP, Cohn DE, et al. Pre-emptive analgesia in gynecologic surgical procedures: preoperative wound infiltration with ropivacaine in patients who undergo laparotomy through a midline vertical incision. Am J Obstet Gynecol 2003; 188:901.
  11. Leung CC, Chan YM, Ngai SW, et al. Effect of pre-incision skin infiltration on post-hysterectomy pain--a double-blind randomized controlled trial. Anaesth Intensive Care 2000; 28:510.
  12. Hadi I, Morley-Forster PK, Dain S, et al. Brief review: perioperative management of the patient with chronic non-cancer pain. Can J Anaesth 2006; 53:1190.
  13. Mitra S, Sinatra RS. Perioperative management of acute pain in the opioid-dependent patient. Anesthesiology 2004; 101:212.
  14. Kehlet H, Dahl JB. The value of "multimodal" or "balanced analgesia" in postoperative pain treatment. Anesth Analg 1993; 77:1048.
  15. Hebl JR, Dilger JA, Byer DE, et al. A pre-emptive multimodal pathway featuring peripheral nerve block improves perioperative outcomes after major orthopedic surgery. Reg Anesth Pain Med 2008; 33:510.
  16. Elia N, Lysakowski C, Tramèr MR. Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials. Anesthesiology 2005; 103:1296.
  17. Trabulsi EJ, Patel J, Viscusi ER, et al. Preemptive multimodal pain regimen reduces opioid analgesia for patients undergoing robotic-assisted laparoscopic radical prostatectomy. Urology 2010; 76:1122.
  18. Tauzin-Fin P, Bernard O, Sesay M, et al. Benefits of intravenous lidocaine on post-operative pain and acute rehabilitation after laparoscopic nephrectomy. J Anaesthesiol Clin Pharmacol 2014; 30:366.
  19. Wongyingsinn M, Baldini G, Charlebois P, et al. Intravenous lidocaine versus thoracic epidural analgesia: a randomized controlled trial in patients undergoing laparoscopic colorectal surgery using an enhanced recovery program. Reg Anesth Pain Med 2011; 36:241.
  20. Yardeni IZ, Beilin B, Mayburd E, et al. The effect of perioperative intravenous lidocaine on postoperative pain and immune function. Anesth Analg 2009; 109:1464.
  21. Dauri M, Faria S, Gatti A, et al. Gabapentin and pregabalin for the acute post-operative pain management. A systematic-narrative review of the recent clinical evidences. Curr Drug Targets 2009; 10:716.
  22. Mathiesen O, Møiniche S, Dahl JB. Gabapentin and postoperative pain: a qualitative and quantitative systematic review, with focus on procedure. BMC Anesthesiol 2007; 7:6.
  23. Seib RK, Paul JE. Preoperative gabapentin for postoperative analgesia: a meta-analysis. Can J Anaesth 2006; 53:461.
  24. Wittels B, Sevarino FB. PCA in the obstetric patient. In: Acute pain: Mechanism and Management, Sinatra, RS, Hord, AH, Ginsberg, B, Preble, LM (Eds), Mosby-Year Book, St. Louis 1992. p.175.
  25. Rapp-Zingraff N, Bayoumeu F, Baka N, et al. Analgesia after caesarean section: patient-controlled intravenous morphine vs epidural morphine. Int J Obstet Anesth 1997; 6:87.
  26. Cade L, Ashley J. Towards optimal analgesia after caesarean section: comparison of epidural and intravenous patient-controlled opioid analgesia. Anaesth Intensive Care 1993; 21:696.
  27. Wittels B, Glosten B, Faure EA, et al. Postcesarean analgesia with both epidural morphine and intravenous patient-controlled analgesia: neurobehavioral outcomes among nursing neonates. Anesth Analg 1997; 85:600.
  28. Chia YY, Liu K, Wang JJ, et al. Intraoperative high dose fentanyl induces postoperative fentanyl tolerance. Can J Anaesth 1999; 46:872.
  29. Latta KS, Ginsberg B, Barkin RL. Meperidine: a critical review. Am J Ther 2002; 9:53.
  30. Hudcova J, McNicol E, Quah C, et al. Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain. Cochrane Database Syst Rev 2006; :CD003348.
  31. Davison SN, Mayo PR. Pain management in chronic kidney disease: the pharmacokinetics and pharmacodynamics of hydromorphone and hydromorphone-3-glucuronide in hemodialysis patients. J Opioid Manag 2008; 4:335.
  32. Murtagh FE, Chai MO, Donohoe P, et al. The use of opioid analgesia in end-stage renal disease patients managed without dialysis: recommendations for practice. J Pain Palliat Care Pharmacother 2007; 21:5.
  33. McDaid C, Maund E, Rice S, et al. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for the reduction of morphine-related side effects after major surgery: a systematic review. Health Technol Assess 2010; 14:1.
  34. Pavy TJ, Paech MJ, Evans SF. The effect of intravenous ketorolac on opioid requirement and pain after cesarean delivery. Anesth Analg 2001; 92:1010.
  35. Mixter CG 3rd, Meeker LD, Gavin TJ. Preemptive pain control in patients having laparoscopic hernia repair: a comparison of ketorolac and ibuprofen. Arch Surg 1998; 133:432.
  36. Bikhazi GB, Snabes MC, Bajwa ZH, et al. A clinical trial demonstrates the analgesic activity of intravenous parecoxib sodium compared with ketorolac or morphine after gynecologic surgery with laparotomy. Am J Obstet Gynecol 2004; 191:1183.
  37. Varrassi G, Marinangeli F, Agrò F, et al. A double-blinded evaluation of propacetamol versus ketorolac in combination with patient-controlled analgesia morphine: analgesic efficacy and tolerability after gynecologic surgery. Anesth Analg 1999; 88:611.
  38. Chui PT, Gin T. A comparison between ketorolac and diclofenac in laparoscopic sterilization. Eur J Anaesthesiol 1995; 12:597.
  39. O'Hanlon JJ, Beers H, Huss BK, Milligan KR. A comparison of the effect of intramuscular diclofenac, ketorolac or piroxicam on post-operative pain following laparoscopy. Eur J Anaesthesiol 1996; 13:404.
  40. Ng A, Temple A, Smith G, Emembolu J. Early analgesic effects of parecoxib versus ketorolac following laparoscopic sterilization: a randomized controlled trial. Br J Anaesth 2004; 92:846.
  41. Quibell R, Prommer EE, Mihalyo M, et al. Ketamine*. J Pain Symptom Manage 2011; 41:640.
  42. Laskowski K, Stirling A, McKay WP, Lim HJ. A systematic review of intravenous ketamine for postoperative analgesia. Can J Anaesth 2011; 58:911.
  43. Carstensen M, Møller AM. Adding ketamine to morphine for intravenous patient-controlled analgesia for acute postoperative pain: a qualitative review of randomized trials. Br J Anaesth 2010; 104:401.
  44. Chaparro LE, Smith SA, Moore RA, et al. Pharmacotherapy for the prevention of chronic pain after surgery in adults. Cochrane Database Syst Rev 2013; 7:CD008307.
  45. McNicol ED, Schumann R, Haroutounian S. A systematic review and meta-analysis of ketamine for the prevention of persistent post-surgical pain. Acta Anaesthesiol Scand 2014; 58:1199.
  46. Marret E, Rolin M, Beaussier M, Bonnet F. Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br J Surg 2008; 95:1331.
  47. Albrecht E, Kirkham KR, Liu SS, Brull R. Peri-operative intravenous administration of magnesium sulphate and postoperative pain: a meta-analysis. Anaesthesia 2013; 68:79.
  48. De Oliveira GS Jr, Castro-Alves LJ, Khan JH, McCarthy RJ. Perioperative systemic magnesium to minimize postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology 2013; 119:178.
  49. Jabbour HJ, Naccache NM, Jawish RJ, et al. Ketamine and magnesium association reduces morphine consumption after scoliosis surgery: prospective randomised double-blind study. Acta Anaesthesiol Scand 2014; 58:572.
  50. Ong CK, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg 2010; 110:1170.
  51. Khan SA, Khokhar HA, Nasr AR, et al. Effect of epidural analgesia on bowel function in laparoscopic colorectal surgery: a systematic review and meta-analysis. Surg Endosc 2013; 27:2581.
  52. Turunen P, Carpelan-Holmström M, Kairaluoma P, et al. Epidural analgesia diminished pain but did not otherwise improve enhanced recovery after laparoscopic sigmoidectomy: a prospective randomized study. Surg Endosc 2009; 23:31.
  53. Werawatganon T, Charuluxanun S. Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database Syst Rev 2005; :CD004088.
  54. Cousins MJ, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiology 1984; 61:276.
  55. Gwirtz KH, Young JV, Byers RS, et al. The safety and efficacy of intrathecal opioid analgesia for acute postoperative pain: seven years' experience with 5969 surgical patients at Indiana University Hospital. Anesth Analg 1999; 88:599.
  56. Palmer CM, Nogami WM, Van Maren G, Alves DM. Postcesarean epidural morphine: a dose-response study. Anesth Analg 2000; 90:887.
  57. Abouleish E, Rawal N, Rashad MN. The addition of 0.2 mg subarachnoid morphine to hyperbaric bupivacaine for cesarean delivery: a prospective study of 856 cases. Reg Anesth 1991; 16:137.
  58. Chestnut DH. Efficacy and safety of epidural opioids for postoperative analgesia. Anesthesiology 2005; 102:221.
  59. Chadwick HS, Ready LB. Intrathecal and epidural morphine sulfate for post-cesarean analgesia--a clinical comparison. Anesthesiology 1988; 68:925.
  60. Satoh O, Hatakeyama Y, Miyazawa F, et al. [Intrathecal morphine for postoperative pain relief after transvaginal hysterectomy]. Masui 1992; 41:1517.
  61. Dualé C, Frey C, Bolandard F, et al. Epidural versus intrathecal morphine for postoperative analgesia after Caesarean section. Br J Anaesth 2003; 91:690.
  62. Terajima K, Onodera H, Kobayashi M, et al. Efficacy of intrathecal morphine for analgesia following elective cesarean section: comparison with previous delivery. J Nippon Med Sch 2003; 70:327.
  63. Sarvela J, Halonen P, Soikkeli A, Korttila K. A double-blinded, randomized comparison of intrathecal and epidural morphine for elective cesarean delivery. Anesth Analg 2002; 95:436.
  64. Abouleish E, Rawal N, Fallon K, Hernandez D. Combined intrathecal morphine and bupivacaine for cesarean section. Anesth Analg 1988; 67:370.
  65. Fassoulaki A, Gatzou V, Petropoulos G, Siafaka I. Spread of subarachnoid block, intraoperative local anaesthetic requirements and postoperative analgesic requirements in Caesarean section and total abdominal hysterectomy. Br J Anaesth 2004; 93:678.
  66. Sarma VJ, Boström UV. Intrathecal morphine for the relief of post-hysterectomy pain--a double-blind, dose-response study. Acta Anaesthesiol Scand 1993; 37:223.
  67. Gadsden J, Hart S, Santos AC. Post-cesarean delivery analgesia. Anesth Analg 2005; 101:S62.
  68. Palmer CM, Cork RC, Hays R, et al. The dose-response relation of intrathecal fentanyl for labor analgesia. Anesthesiology 1998; 88:355.
  69. Singh SI, Rehou S, Marmai KL, Jones PM. The efficacy of 2 doses of epidural morphine for postcesarean delivery analgesia: a randomized noninferiority trial. Anesth Analg 2013; 117:677.
  70. Niiyama Y, Kawamata T, Shimizu H, et al. The addition of epidural morphine to ropivacaine improves epidural analgesia after lower abdominal surgery. Can J Anaesth 2005; 52:181.
  71. Wu CL, Hurley RW, Anderson GF, et al. Effect of postoperative epidural analgesia on morbidity and mortality following surgery in medicare patients. Reg Anesth Pain Med 2004; 29:525.
  72. de Leon-Casasola OA, Karabella D, Lema MJ. Bowel function recovery after radical hysterectomies: thoracic epidural bupivacaine-morphine versus intravenous patient-controlled analgesia with morphine: a pilot study. J Clin Anesth 1996; 8:87.
  73. Jørgensen H, Fomsgaard JS, Dirks J, et al. Effect of epidural bupivacaine vs combined epidural bupivacaine and morphine on gastrointestinal function and pain after major gynaecological surgery. Br J Anaesth 2001; 87:727.
  74. Jørgensen H, Fomsgaard JS, Dirks J, et al. Effect of continuous epidural 0.2% ropivacaine vs 0.2% bupivacaine on postoperative pain, motor block and gastrointestinal function after abdominal hysterectomy. Br J Anaesth 2000; 84:144.
  75. Tanaka M, Watanabe S, Ashimura H, et al. Minimum effective combination dose of epidural morphine and fentanyl for posthysterectomy analgesia: a randomized, prospective, double-blind study. Anesth Analg 1993; 77:942.
  76. Senard M, Kaba A, Jacquemin MJ, et al. Epidural levobupivacaine 0.1% or ropivacaine 0.1% combined with morphine provides comparable analgesia after abdominal surgery. Anesth Analg 2004; 98:389.
  77. Senard M, Joris JL, Ledoux D, et al. A comparison of 0.1% and 0.2% ropivacaine and bupivacaine combined with morphine for postoperative patient-controlled epidural analgesia after major abdominal surgery. Anesth Analg 2002; 95:444.
  78. Scott DA, Blake D, Buckland M, et al. A comparison of epidural ropivacaine infusion alone and in combination with 1, 2, and 4 microg/mL fentanyl for seventy-two hours of postoperative analgesia after major abdominal surgery. Anesth Analg 1999; 88:857.
  79. Jørgensen H, Wetterslev J, Møiniche S, Dahl JB. Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst Rev 2000; :CD001893.
  80. Gambling DR, Yu P, Cole C, et al. A comparative study of patient controlled epidural analgesia (PCEA) and continuous infusion epidural analgesia (CIEA) during labour. Can J Anaesth 1988; 35:249.
  81. Liu SS, Allen HW, Olsson GL. Patient-controlled epidural analgesia with bupivacaine and fentanyl on hospital wards: prospective experience with 1,030 surgical patients. Anesthesiology 1998; 88:688.
  82. Chia YY, Chang TH, Liu K, et al. The efficacy of thoracic epidural neostigmine infusion after thoracotomy. Anesth Analg 2006; 102:201.
  83. Lauretti GR, de Oliveira R, Reis MP, et al. Study of three different doses of epidural neostigmine coadministered with lidocaine for postoperative analgesia. Anesthesiology 1999; 90:1534.
  84. Wilson JA, Nimmo AF, Fleetwood-Walker SM, Colvin LA. A randomised double blind trial of the effect of pre-emptive epidural ketamine on persistent pain after lower limb amputation. Pain 2008; 135:108.
  85. Subramaniam K, Subramaniam B, Steinbrook RA. Ketamine as adjuvant analgesic to opioids: a quantitative and qualitative systematic review. Anesth Analg 2004; 99:482.
  86. Farmery AD, Wilson-MacDonald J. The analgesic effect of epidural clonidine after spinal surgery: a randomized placebo-controlled trial. Anesth Analg 2009; 108:631.
  87. De Kock M, Wiederkher P, Laghmiche A, Scholtes JL. Epidural clonidine used as the sole analgesic agent during and after abdominal surgery. A dose-response study. Anesthesiology 1997; 86:285.
  88. American Society of Anesthesiologists Task Force on Neuraxial Opioids, Horlocker TT, Burton AW, et al. Practice guidelines for the prevention, detection, and management of respiratory depression associated with neuraxial opioid administration. Anesthesiology 2009; 110:218.
  89. Devys JM, Mora A, Plaud B, et al. Intrathecal + PCA morphine improves analgesia during the first 24 hr after major abdominal surgery compared to PCA alone. Can J Anaesth 2003; 50:355.
  90. Kong SK, Onsiong SM, Chiu WK, Li MK. Use of intrathecal morphine for postoperative pain relief after elective laparoscopic colorectal surgery. Anaesthesia 2002; 57:1168.
  91. Swart M, Sewell J, Thomas D. Intrathecal morphine for caesarean section: an assessment of pain relief, satisfaction and side-effects. Anaesthesia 1997; 52:373.
  92. Horlocker TT, Wedel DJ, Rowlingson JC, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med 2010; 35:64.
  93. Chin KJ, Singh M, Velayutham V, Chee V. Infraclavicular brachial plexus block for regional anaesthesia of the lower arm. Cochrane Database Syst Rev 2010; :CD005487.
  94. Fredrickson MJ, Krishnan S, Chen CY. Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. Anaesthesia 2010; 65:608.
  95. Wegener JT, van Ooij B, van Dijk CN, et al. Value of single-injection or continuous sciatic nerve block in addition to a continuous femoral nerve block in patients undergoing total knee arthroplasty: a prospective, randomized, controlled trial. Reg Anesth Pain Med 2011; 36:481.
  96. Ilfeld BM, Mariano ER, Girard PJ, et al. A multicenter, randomized, triple-masked, placebo-controlled trial of the effect of ambulatory continuous femoral nerve blocks on discharge-readiness following total knee arthroplasty in patients on general orthopaedic wards. Pain 2010; 150:477.
  97. Paul JE, Arya A, Hurlburt L, et al. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology 2010; 113:1144.
  98. Fowler SJ, Symons J, Sabato S, Myles PS. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth 2008; 100:154.
  99. Kopacz DJ, Thompson GE. Intercostal blocks for thoracic and abdominal surgery. Tech Reg Anesth Pain Manage 1998; 2:25.
  100. Nunn JF, Slavin G. Posterior intercostal nerve block for pain relief after cholecystectomy. Anatomical basis and efficacy. Br J Anaesth 1980; 52:253.
  101. Coveney E, Weltz CR, Greengrass R, et al. Use of paravertebral block anesthesia in the surgical management of breast cancer: experience in 156 cases. Ann Surg 1998; 227:496.
  102. Kopacz, DJ, Thompson, GE. Neural blockade of the Thorax and abdomen. In: Neuronal Blockade in Clinical Anesthesia and Management of Pain, Cousins, MJ, Bridenbaugh, PO (Eds), JB Lippincott-Raven Publishers, Philadelphia 1988. p.451.
  103. Klein SM, Bergh A, Steele SM, et al. Thoracic paravertebral block for breast surgery. Anesth Analg 2000; 90:1402.
  104. McDonnell JG, O'Donnell B, Curley G, et al. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg 2007; 104:193.
  105. McDonnell JG, Curley G, Carney J, et al. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg 2008; 106:186.
  106. Carney J, McDonnell JG, Ochana A, et al. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anesth Analg 2008; 107:2056.
  107. Aveline C, Le Hetet H, Le Roux A, et al. Comparison between ultrasound-guided transversus abdominis plane and conventional ilioinguinal/iliohypogastric nerve blocks for day-case open inguinal hernia repair. Br J Anaesth 2011; 106:380.
  108. Favuzza J, Delaney CP. Outcomes of discharge after elective laparoscopic colorectal surgery with transversus abdominis plane blocks and enhanced recovery pathway. J Am Coll Surg 2013; 217:503.
  109. Favuzza J, Brady K, Delaney CP. Transversus abdominis plane blocks and enhanced recovery pathways: making the 23-h hospital stay a realistic goal after laparoscopic colorectal surgery. Surg Endosc 2013; 27:2481.
  110. Walter CJ, Maxwell-Armstrong C, Pinkney TD, et al. A randomised controlled trial of the efficacy of ultrasound-guided transversus abdominis plane (TAP) block in laparoscopic colorectal surgery. Surg Endosc 2013; 27:2366.
  111. Dahl JB, Nielsen RV, Wetterslev J, et al. Post-operative analgesic effects of paracetamol, NSAIDs, glucocorticoids, gabapentinoids and their combinations: a topical review. Acta Anaesthesiol Scand 2014; 58:1165.
  112. Ng A, Smith G, Davidson AC. Analgesic effects of parecoxib following total abdominal hysterectomy. Br J Anaesth 2003; 90:746.
  113. Thompson JP, Sharpe P, Kiani S, Owen-Smith O. Effect of meloxicam on postoperative pain after abdominal hysterectomy. Br J Anaesth 2000; 84:151.
  114. Akarsu T, Karaman S, Akercan F, et al. Preemptive meloxicam for postoperative pain relief after abdominal hysterectomy. Clin Exp Obstet Gynecol 2004; 31:133.
  115. Chan A, Doré CJ, Ramachandra V. Analgesia for day surgery. Evaluation of the effect of diclofenac given before or after surgery with or without bupivacaine infiltration. Anaesthesia 1996; 51:592.
  116. Clarke R, Derry S, Moore RA, McQuay HJ. Single dose oral etoricoxib for acute postoperative pain in adults. Cochrane Database Syst Rev 2009; :CD004309.
  117. Lloyd R, Derry S, Moore RA, McQuay HJ. Intravenous or intramuscular parecoxib for acute postoperative pain in adults. Cochrane Database Syst Rev 2009; :CD004771.
  118. Derry S, Moore RA. Single dose oral celecoxib for acute postoperative pain in adults. Cochrane Database Syst Rev 2013; 10:CD004233.
  119. Barton SF, Langeland FF, Snabes MC, et al. Efficacy and safety of intravenous parecoxib sodium in relieving acute postoperative pain following gynecologic laparotomy surgery. Anesthesiology 2002; 97:306.
  120. Malan TP Jr, Gordon S, Hubbard R, Snabes M. The cyclooxygenase-2-specific inhibitor parecoxib sodium is as effective as 12 mg of morphine administered intramuscularly for treating pain after gynecologic laparotomy surgery. Anesth Analg 2005; 100:454.
  121. Bikhazi GB, Bajwa ZH, Snabes MC, et al. Parecoxib effectively treats post-laparotomy pain. Annual Meeting of the American Society for Reproductive Medicine Poster 2003; 481.
  122. Gordh T Jr, Jansson I, Hartvig P, et al. Interactions between noradrenergic and cholinergic mechanisms involved in spinal nociceptive processing. Acta Anaesthesiol Scand 1989; 33:39.
  123. Gold MS, Redmond DE Jr, Kleber HD. Clonidine blocks acute opiate-withdrawal symptoms. Lancet 1978; 2:599.
  124. De Kock M, Crochet B, Morimont C, Scholtes JL. Intravenous or epidural clonidine for intra- and postoperative analgesia. Anesthesiology 1993; 79:525.
  125. Omote K, Kitahata LM, Collins JG, et al. Interaction between opiate subtype and alpha-2 adrenergic agonists in suppression of noxiously evoked activity of WDR neurons in the spinal dorsal horn. Anesthesiology 1991; 74:737.
  126. Sung CS, Lin SH, Chan KH, et al. Effect of oral clonidine premedication on perioperative hemodynamic response and postoperative analgesic requirement for patients undergoing laparoscopic cholecystectomy. Acta Anaesthesiol Sin 2000; 38:23.
  127. Hidalgo MP, Auzani JA, Rumpel LC, et al. The clinical effect of small oral clonidine doses on perioperative outcomes in patients undergoing abdominal hysterectomy. Anesth Analg 2005; 100:795.
  128. White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg 2005; 101:S5.
  129. Zhang J, Ho KY, Wang Y. Efficacy of pregabalin in acute postoperative pain: a meta-analysis. Br J Anaesth 2011; 106:454.
  130. Ho KY, Gan TJ, Habib AS. Gabapentin and postoperative pain--a systematic review of randomized controlled trials. Pain 2006; 126:91.
  131. Tiippana EM, Hamunen K, Kontinen VK, Kalso E. Do surgical patients benefit from perioperative gabapentin/pregabalin? A systematic review of efficacy and safety. Anesth Analg 2007; 104:1545.
  132. Peng PW, Wijeysundera DN, Li CC. Use of gabapentin for perioperative pain control -- a meta-analysis. Pain Res Manag 2007; 12:85.
  133. Moore RA, Straube S, Wiffen PJ, et al. Pregabalin for acute and chronic pain in adults. Cochrane Database Syst Rev 2009; :CD007076.
  134. Dirks J, Fredensborg BB, Christensen D, et al. A randomized study of the effects of single-dose gabapentin versus placebo on postoperative pain and morphine consumption after mastectomy. Anesthesiology 2002; 97:560.
  135. Fassoulaki A, Patris K, Sarantopoulos C, Hogan Q. The analgesic effect of gabapentin and mexiletine after breast surgery for cancer. Anesth Analg 2002; 95:985.
  136. Dierking G, Duedahl TH, Rasmussen ML, et al. Effects of gabapentin on postoperative morphine consumption and pain after abdominal hysterectomy: a randomized, double-blind trial. Acta Anaesthesiol Scand 2004; 48:322.
  137. Pandey CK, Priye S, Singh S, et al. Preemptive use of gabapentin significantly decreases postoperative pain and rescue analgesic requirements in laparoscopic cholecystectomy. Can J Anaesth 2004; 51:358.
  138. Turan A, Karamanlioğlu B, Memiş D, et al. Analgesic effects of gabapentin after spinal surgery. Anesthesiology 2004; 100:935.
  139. Turan A, Karamanlioğlu B, Memiş D, et al. The analgesic effects of gabapentin after total abdominal hysterectomy. Anesth Analg 2004; 98:1370.
  140. Rorarius MG, Mennander S, Suominen P, et al. Gabapentin for the prevention of postoperative pain after vaginal hysterectomy. Pain 2004; 110:175.
  141. Radhakrishnan M, Bithal PK, Chaturvedi A. Effect of preemptive gabapentin on postoperative pain relief and morphine consumption following lumbar laminectomy and discectomy: a randomized, double-blinded, placebo-controlled study. J Neurosurg Anesthesiol 2005; 17:125.
  142. Young A, Buvanendran A. Recent advances in multimodal analgesia. Anesthesiol Clin 2012; 30:91.
  143. Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol 2009; 22:588.
  144. Jin F, Chung F. Multimodal analgesia for postoperative pain control. J Clin Anesth 2001; 13:524.
  145. White PF. Multimodal analgesia: its role in preventing postoperative pain. Curr Opin Investig Drugs 2008; 9:76.
  146. Heit HA, Gourlay DL. Buprenorphine: new tricks with an old molecule for pain management. Clin J Pain 2008; 24:93.
  147. Orman JS, Keating GM. Buprenorphine/naloxone: a review of its use in the treatment of opioid dependence. Drugs 2009; 69:577.
  148. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet 2006; 367:1618.