Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines

Federico Coccolini, Francesco Corradi, Massimo Sartelli, Raul Coimbra, Igor A. Kryvoruchko, Ari Leppaniemi, Krstina Doklestic, Elena Bignami, Giandomenico Biancofiore, Miklosh Bala, Ceresoli Marco, Dimitris Damaskos, Walt L. Biffl, Paola Fugazzola, Domenico Santonastaso, Vanni Agnoletti, Catia Sbarbaro, Mirco Nacoti, Timothy C. Hardcastle, Diego MarianiBelinda De Simone, Matti Tolonen, Chad Ball, Mauro Podda, Isidoro Di Carlo, Salomone Di Saverio, Pradeep Navsaria, Luigi Bonavina, Fikri Abu-Zidan, Kjetil Soreide, Gustavo P. Fraga, Vanessa Henriques Carvalho, Sergio Faria Batista, Andreas Hecker, Alessandro Cucchetti, Giorgio Ercolani, Dario Tartaglia, Joseph M. Galante, Imtiaz Wani, Hayato Kurihara, Edward Tan, Andrey Litvin, Rita Maria Melotti, Gabriele Sganga, Tamara Zoro, Alessandro Isirdi, Nicola De’Angelis, Dieter G. Weber, Adrien M. Hodonou, Richard tenBroek, Dario Parini, Jim Khan, Giovanni Sbrana, Carlo Coniglio, Antonino Giarratano, Angelo Gratarola, Claudia Zaghi, Oreste Romeo, Michael Kelly, Francesco Forfori, Massimo Chiarugi, Ernest E. Moore, Fausto Catena, Manu L.N.G. Malbrain

Research output: Contribution to journalReview articlepeer-review

9 Citations (Scopus)

Abstract

Background: Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. Material and methods: An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. Conclusion: Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies.

Original languageEnglish
Article number50
JournalWorld Journal of Emergency Surgery
Volume17
Issue number1
DOIs
Publication statusPublished - Dec 2022

Keywords

  • Acute
  • Acute
  • Emergency
  • Morbidity
  • Pain
  • Surgery
  • Treatment

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine

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