Perioperative Analgesia With Nonopioid Analgesics

Background: Nonopioid analgesics are frequently used for perioperative analgesia; however, insuffcient research is available on several practical issues. Often hospitals have no strategy for how to proceed, e.g., when informing patients or timing the perioperative administration of nonopioid analgesics.Methods: An expert panel representing the German national societies of pain, anaesthesiology and intensive care medicine and surgery developed recommendations for the perioperative use of nonopioid analgesics within a formal, structured consensus process.Results: The panel agreed that nonopioid analgesics should be part of a multimodal analgesia concept and that patients have to be informed preoperatively about possible complications and alternative treatment options. Patients' history of pain and analgesic intake should be evaluated. Patients at risk of severe postoperative pain and possible chronification of postsurgical pain should be identified. Depending on the duration of surgery, nonopioid analgesics can already be administered preoperatively or intraoperatively so that plasma concentrations are sufficient after emergence from anaesthesia. Nonopioid analgesics or combinations of analgesics should be administered for a limited time only. An interdisciplinary written standard of care, comprising the nonopioid analgesic of choice, possible alternatives, adequate dosing and timing of administration as well as surgery specific policies, have to be agreed upon by all departments involved. At discharge, the patient's physician should be informed of analgesics given and those necessary after discharge. Patients should be in-formed of possible side effects and symptoms and timely discontinuation of analgesic drugs.Conclusion: The use of nonopioid analgesics as part of a perioperative multimodal concept should be approved and established as an interdisciplinary and interprofessional concept for the adequate treatment of postoperative pain.