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

Abstract

PRACTICE Guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints and are not intended to replace local institutional policies. In addition, Practice Guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome. Practice Guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. They provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open forum commentary, and clinical feasibility data.This document updates the “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,” adopted by the ASA in 2003 and published in 2004.*For these Guidelines, acute pain is defined as pain that is present in a surgical patient after a procedure. Such pain may be the result of trauma from the procedure or procedure-related complications. Pain management in the perioperative setting refers to actions before, during, and after a procedure that are intended to reduce or eliminate postoperative pain before discharge.The purpose of these Guidelines is to (1) facilitate the safety and effectiveness of acute pain management in the perioperative setting; (2) reduce the risk of adverse outcomes; (3) maintain the patient's functional abilities, as well as physical and psychologic well-being; and (4) enhance the quality of life for patients with acute pain during the perioperative period. Adverse outcomes that may result from the undertreatment of perioperative pain include (but are not limited to) thromboembolic and pulmonary complications, additional time spent in an intensive care unit or hospital, hospital readmission for further pain management, needless suffering, impairment of health-related quality of life, and development of chronic pain. Adverse outcomes associated with the management of perioperative pain include (but are not limited to) respiratory depression, brain or other neurologic injury, sedation, circulatory depression, nausea, vomiting, pruritus, urinary retention, impairment of bowel function, and sleep disruption. Health-related quality of life includes (but is not limited to) physical, emotional, social, and spiritual well-being.These Guidelines focus on acute pain management in the perioperative setting for adult (including geriatric) and pediatric patients undergoing either inpatient or outpatient surgery. Modalities for perioperative pain management addressed in these Guidelines require a higher level of professional expertise and organizational structure than “as needed” intramuscular or intravenous injections of opioid analgesics. These Guidelines are not intended as an exhaustive compendium of specific techniques.Patients with severe or concurrent medical illness such as sickle cell crisis, pancreatitis, or acute pain related to cancer or cancer treatment may also benefit from aggressive pain control. Labor pain is another condition of interest to anesthesiologists. However, the complex interactions of concurrent medical therapies and physiologic alterations make it impractical to address pain management for these populations within the context of this document.Although patients undergoing painful procedures may benefit from the appropriate use of anxiolytics and sedatives in combination with analgesics and local anesthetics when indicated, these Guidelines do not specifically address the use of anxiolysis or sedation during such procedures.These Guidelines are intended for use by anesthesiologists and individuals who deliver care under the supervision of anesthesiologists. The Guidelines may also serve as a resource for other physicians and healthcare professionals who manage perioperative pain. In addition, these Guidelines may be used by policymakers to promote effective and patient-centered care.Anesthesiologists bring an exceptional level of interest and expertise to the area of perioperative pain management. Anesthesiologists are uniquely qualified and positioned to provide leadership in integrating pain management within perioperative care. In this leadership role, anesthesiologists improve quality of care by developing and directing institution-wide, interdisciplinary perioperative analgesia programs.The original Guidelines were developed by an ASA appointed task force of 11 members, consisting of anesthesiologists in private and academic practices from various geographic areas of the United States, and two consulting methodologists from the ASA Committee on Standards and Practice Parameters.The Task Force updated the Guidelines by means of a seven-step