Optimizing XXXX management to facilitate Enhanced Recovery After Surgery pathways.

@entity1 @entity1024 @entity1246 @entity2951 @entity1337 @entity1576 @entity158 @entity1443 @entity282 @entity1209
PURPOSE: The optimal management of @entity282 using multimodal @entity1337 is a key component of Enhanced Recovery After Surgery (ERAS). @entity158 has adverse clinical implications on postoperative recovery, including prolonging the time to recovery milestones and length of hospital stay. Moreover, the ubiquity of opioids in postoperative analgesic regimens results in adverse effects, such as sedation, @entity1209 , urinary retention, ileus, and @entity1576 , which can delay discharge. Thus, multimodal @entity1337 , i.e., the use of more than one analgesic modality to achieve @entity158 control while reducing opioid-related side effects, has become the cornerstone of enhanced recovery. The purpose of this review is to address the analgesic techniques used as part of multimodal analgesic regimens to optimize @entity282 control and to summarize the evidence for their use in reducing opioid requirements and side effects. PRINCIPAL FINDINGS: There is a wide variety of analgesic techniques available for multimodal postoperative @entity1337 . These modalities are divided into pharmacological and non-pharmacological techniques. Systemic pharmacological modalities involve opioids and non-opioids such as @entity1443 , non-steroidal anti-inflammatory drugs, @entity1024 receptor antagonists, anticonvulsants (e.g., @entity1246 analogues), beta-blockers, alpha-2 agonists, transient receptor potential vanilloid receptor agonists ( @entity2951 ), and glucocorticoids. Other pharmacological modalities include central neuraxial techniques, surgical-site infiltration, and regional anesthesia. Evidence supports the use of these pharmacological techniques as part of multimodal @entity1337 , but each has its own advantages and specific safety profile, which highlights the importance of selecting the appropriate analgesics for each @entity1 . Adjunctive non-pharmacological techniques include acupuncture, music therapy, transcutaneous electrical nerve stimulation, and hypnosis. There is mixed evidence regarding such techniques, although a lack of harm is associated with their use. CONCLUSION: There are continuing advancements in multimodal analgesic techniques; however, @entity282 in general continues to be undermanaged. Furthermore, a continuing challenge in multimodal @entity158 research related to ERAS is the difficulty in carrying out randomized trials to determine the relative importance of any one component, including @entity1337 .
