Use a multimodal approach to reduce postsurgical pain and opioid use

Opioid-minimizing strategies can enhance recovery after surgery. Multimodal analgesia is the utilization of multiple pain management modalities for more effective pain control, which can lead to enhanced clinical and economic benefits

Decreases in…

  • Opioid use1
  • Length of hospital stay1,2
  • Acute postsurgical pain3
  • Risk of developing chronic pain4
  • Postsurgical complications5
  • Cost per patient1,2

Improvement in…

  • Efficiency of hospital resources1,2
  • Patient satisfaction3,5,6

Multiple important organizations across specialties echo the need for improved multimodal pain management strategies, which are key for improved outcomes

AAOMS

Oral/Maxillofacial

AAOMS also supports multimodal pain management strategies, such as the use of long-acting local anesthetics during surgery and NSAIDs either presurgically and/or postsurgically for acute pain control in conjunction with the judicious use of opioids or as a substitute.7

APS, ASRA, ASA

Anesthesiology

Recommendation for site-specific local anesthetic infiltration for surgical procedures, noting that “clinicians should be knowledgeable regarding specific local anesthetic infiltration techniques, including the use of extended-release formulations of local anesthetics, such as liposomal bupivacaine.” The guideline notes that use of local anesthetic infiltration should be on the basis of evidence showing benefit for the surgical procedure in question.8

ASCRS, SAGES

Colorectal Surgery

Strong recommendation for the use of a perisurgical multimodal, opioid-sparing, pain management plan, noting that liposomal bupivacaine wound infiltration and transversus abdominis plane (TAP) blocks “have shown promising results in patients undergoing open and laparoscopic colorectal surgery.”9

ERAS Society

Breast Reconstruction

Strong recommendation for the use of multimodal opioid-sparing postsurgical pain management regimens, noting that “a single injection of liposomal bupivacaine lasts for several days, potentially avoiding the need for catheter-based infusions.”10

ERAS Society

Gynecologic Oncology

Strong recommendation for a multimodal postsurgical analgesic protocol using non-opioid oral medications and incisional injection of local anesthetic to decrease the need for systemic medications, stating that “incisional infiltration with either bupivacaine or liposomal bupivacaine has no systemic side effects when used appropriately and should be incorporated into all ERAS protocols as a component of multimodal analgesia.”11

ERAS Society, ESTS

Thoracic Surgery

Recommends peripheral nerve blocks over thoracic epidural, and notes that “liposomal bupivacaine also shows promise when delivered as multilevel intercostal injections potentially providing blockade of intercostal nerves for up to 96 hours.”12

Long-lasting non-opioid EXPAREL is proven to be an important part of multimodal analgesia

EXPAREL uses DepoFoam®technology to encapsulate the local anesthetic bupivacaine in multivesicular liposomes to reliably release bupivacaine over time

Targets the pain signal at the surgical site

Reduces the need for opioids* while providing long-lasting postsurgical pain control

Avoids external barriers to earlier ambulation, such as catheters, pumps, devices, and medicines that cause impairment

*The clinical benefit of the decrease in opioid consumption was not demonstrated in pivotal trials.

AAOMS, American Association of Oral and Maxillofacial Surgeons; APS, American Pain Society; ASRA, American Society of Regional Anesthesia and Pain Medicine; ASA, American Society of Anesthesiologists; ASCRS, American Society of Colon and Rectal Surgeons; SAGES, Society of American Gastrointestinal and Endoscopic Surgeons; ERAS, Enhanced Recovery After Surgery; ESTS, European Society of Thoracic Surgeons.