ERAS Protocols and Multimodal Pain Management in Surgery

Abstract

Pain is inherent to trauma and surgery, either by direct tissue trauma or by the activation of a surgical stress response characterized by endocrine, metabolic, and immunologic responses. Most pain from trauma and surgery is nociceptive in nature, but patients may also experience inflammatory and neuropathic pain. Therefore, it is necessary to consider the clinical context, patient factors, the type of trauma injury and surgery, the extent and degree of tissue involvement, and the severity of the response when deciding on pain management choices. In the past, surgery was approached mostly in an open fashion and led to a greater stress response and pain. Over the last 30 years, the minimally invasive approach with laparoscopic and robotic surgery has improved the experience of patients with regard to peri-operative pain. In addition, the advent of enhanced recovery protocols have sought to minimize this surgical stress response through targeting of pain control and pain management regimens. This chapter will focus on enhanced recovery after surgery protocols and multimodal pain regimens and will consider trauma and cancer patients as examples of surgical patients who benefit from this type of approach.