Postoperative Pain in Orthopedics

*Lourdes Trinidad Castillo García, Fabiola Estela Elizabeth Ortega Ponce and Aurora Carolina Martínez Esparza*

### **Abstract**

Most patients who undergo orthopedic surgery experience moderate-to-severe discomfort. Historically, opioids have been the primary medication class used to treat pain transmission pathways. In orthopedic practice, multimodal analgesia has become the predominant method of pain management. Utilizing multiple medications to treat post-surgical pain reduces the need for narcotics and accelerates the healing process. By introducing effective analgesic treatments and interventions, this procedure reduces the use of perioperative opioids and, over time, the risk of opioid toxicity and addiction. Previous research has demonstrated that multimodal analgesia reduces the use of analgesics in the early postoperative period for orthopedic procedures. Numerous substances can stimulate or sensitize directly. When the peripheral nociceptors are damaged, direct damage to the nervous system results in pain. Preoperative, intraoperative, and postoperative symptoms are essential. The emphasis is on management regimes and the pathophysiology underlying the mechanism for postoperative discomfort. A concise description of the effects of painkillers is provided. containing information on specific conditions and average dosage substances are classified further. Both neuropathy and subjective pain should be treated. By focusing on multimodal analgesia, anesthesiologists can reduce pain more effectively. More advanced techniques are utilized for postoperative pain management after orthopedic surgery, thereby enhancing the patient's short- and long-term outcomes.

**Keywords:** orthopedic surgery, multimodal analgesia, pain management, anesthesiology, regional anesthesia, opioids

#### **1. Introduction**

One of the most painful operations a patient can have is orthopedic surgery. Pain is defined as "A unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage" by the new International Association for the Study of Pain (IASP) definition. Most patients who undergo orthopedic surgery, particularly total joint replacement, experience moderate to severe pain.

One of the most significant developments in the field of total joint replacement surgery has been the improvement of pain management. In these patients, effective pain management speeds up recovery, accelerates healing, and enhances quality of

life after surgery. According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), pain has evolved into the "fifth vital sign" and must be taken into account when providing care for all patients. Throughout the entire inpatient and outpatient course, as well as when deciding whether to discharge a patient, pain must be taken into account. Pain must be treated, and failing to do so may result in medical malpractice claims. Since Professor Henrik Kehlet first proposed the idea of Enhanced Recovery After Surgery (ERAS), multimodal analgesia has gained popularity as a technique for treating pain. It requires for multidisciplinary cooperation between patients, doctors, anesthesiologists, physiotherapists, occupational therapists, and nursing staff and involves preoperative, perioperative, and postoperative components. When post-surgical pain is treated with multiple approaches, such as psychotherapy, physical therapy, regional anesthesia, local injections, and non-opioid medications, the recovery process is sped up, the need for opioids is reduced, and the risk of abuse is reduced. Multimodal analgesia has been proven in prior research to reduce both the length of stay and discomfort in the initial 24 hours following foot and ankle surgery. Opioid use was decreased postoperatively by combining periarticular injections with usual pain management for hip hemiarthroplasty. Injections at the surgical site for femur fracture and upper extremity surgeries reduced pain and raised overall patient satisfaction.
