Surgical & Healthcare Alliance for enhanced Recovery & Pain Management (SHARP) Six Part Mini-Lecture Series-FREE NO CME-Postoperative Pain Management (1080p HD)

Video Transcription

Video Summary

Dr. Jennifer Ha’s final lecture reviews strategies for post-operative pain control and preventing/treating persistent post-surgical pain (PPSP). Evidence from a large network meta-analysis suggests regional anesthesia and SNRIs can reduce PPSP risk, and combinations of nerve blocks with ketamine (NMDA antagonists) or gabapentinoids may help. A key predictor of long-term outcomes is early post-op pain trajectory—better immediate pain control is linked to lower risk of chronic pain months later.<br /><br />The lecture discusses opioid-free anesthesia (using agents like ketamine, dexmedetomidine, lidocaine and regional techniques). It reduces nausea/vomiting with similar pain control, but effects on discharge opioid prescribing and chronic pain prevention are unclear; some protocols exclude higher-risk patients and agents like dexmedetomidine have hemodynamic risks.<br /><br />For discharge planning, continue scheduled acetaminophen/NSAIDs, prescribe minimal opioids (or none if no opioids needed for 24 hours pre-discharge), avoid high-dose prescriptions, use PDMP checks, provide storage/disposal education, consider texting follow-up, focus on function, and co-prescribe naloxone for higher-risk patients.<br /><br />Nonpharmacologic and psychological options include early PT, cryotherapy, TENS, acupuncture, massage, yoga, CBT, mindfulness, hypnotherapy, biofeedback, music, imagery, and relaxation. PPSP (3–6+ months) may involve nerve injury and central sensitization; pain specialists may use topicals (lidocaine, high-dose capsaicin), diagnostic blocks, radiofrequency/cryo techniques, peripheral nerve stimulation, spinal cord or DRG stimulation, and surgery in select cases.

Keywords

persistent post-surgical pain (PPSP) prevention

post-operative pain trajectory predictor

regional anesthesia and nerve blocks

opioid-free anesthesia (ketamine dexmedetomidine lidocaine)

multimodal analgesia (SNRIs gabapentinoids NMDA antagonists)

discharge opioid prescribing and naloxone co-prescribing

nonpharmacologic pain management (PT CBT mindfulness TENS)