Pain Management in Enhanced Recovery after Emergency Surgery

*K. Madan and Ramya B. Sriram*

#### **Abstract**

Patients presenting with acute abdominal pain frequently need very good analgesia. In order to obtain successful analgesia, pain should be evaluated, and a suitable intervention should be performed employing multimodal analgesic techniques and a minimum dose of opioid with appropriate monitoring as opioids raise the possibility of the patient being over-sedated, experience hypoventilation, or possibly aspirate. ERAS protocol is a multimodal and multidisciplinary approach to peri-operative management which aims for evidence-based reduction of physiological stress, post-operative complications and organ dysfunction, reoccurrence and mortality whilst also increasing mobility, ultimately leading to early discharge and better surgical outcomes. Multimodal analgesia has an advantage where different techniques are used to tackle pain by targeting different receptors in the pain pathway. Here we discuss a number of multimodal analgesic therapies used to alleviate acute postoperative pain in emergency surgeries, explains their advantages, and evaluates relevant findings and evidence-based management guidelines.

**Keywords:** postoperative pain, ERAS, emergency surgeries, opioid sparing, multimodal analgesia

### **1. Introduction**

Acute postoperative pain is one of the biggest challenges for both surgeons and anaesthesiologists which affects more than 80% of patients who have surgery with less than 75% of them reporting its severity [1]. However, the use of opioids for pain control in the postoperative period is associated with serious adverse effects like respiratory depression, prolonged hospital stays and opioid addiction on chronic use which impedes enhanced recovery of the patients [2]. Hence enhanced recovery after surgery (ERAS) society has given many guidelines specific to various surgeries which advocates the use of multimodal opioid sparing techniques as they prevent the above-mentioned side effects and helps in early mobilisation and fast return of bowel movements, especially in emergency surgeries [3].
