Pharmacology and Perioperative Considerations of Pain Medications

Abstract

Background: Pain continues to be the most common medical concern, and perioperative health care providers are encountering increasing numbers of patients with chronic pain conditions. It is important to have a clear understanding of how long-term use of pain medications impacts anesthesia during the intraoperative and postoperative periods.

Objective: To review common medications used to treat chronic pain and summarize current recommendations regarding perioperative care.

Method: We reviewed the literature by searching PubMed and Google Scholar for articles from 2000-2016. The search strategy included searching for the various classes of pain medications and including the terms perioperative, anesthesiology, and recommendations. We also reviewed the reference lists of each article to identify other relevant sources regarding the perioperative management of pain medications.

Results: After the literature review, we were able to establish the pharmacology, anesthetic interactions, and recommendations for management of each of the common classes of pain medication.

Conclusion: Management of postoperative pain is an important concern for all perioperative health care providers. Although most pain medications should be continued in the perioperative period, it is important to preoperatively discontinue those that antagonize pain receptors to avoid significant postoperative morbidities associated with poorly managed pain.

Keywords: Acetaminophen; nonsteroidal anti-inflammatory drugs; opioid; pain management; perioperative surgical home; preoperative evaluation; surgery.