PHARMACOLOGICAL APPROACHES TO PERIOPERATIVE PAIN MANAGEMENT: BEYOND OPIOIDS

Abstract

The whole attitude towards periop pain management has changed over the years, as those who understood the negative effects of opioids, dependency, postoperative complications, respiratory depression, nausea and vomiting, ileus and delayed healing, have increased. As it becomes ever more common to promote the use of multimodal analgesia strategies that aim to decrease the use of opioids and improve postoperative results. As it becomes more common to advocate for the promotion of multimodal analgesia strategies that aim to reduce the amount of opioids used and improve postoperative results. Therefore, the increased relevance of innovations and pharmacological interventions other than opioids in peri-operative care. Nonsteroidal anti-inflammatory drugs (NSAIDs), gabapentinoids, ketamine, alpha-2 adrenergic agonists, lidocaine infusion, corticosteroids, acetaminophen, and other adjuvants have been shown to have a significant effect in decreasing postoperative pain intensity, improving functional recovery, and reducing opioid consumption in a variety of surgeries. In this current study a different analytical frame is applied to examine in another light the effectiveness of drug therapy for the management of perioperative pain in a broader sense than with opioids. This study aims to assess the efficacy of NSAIDs, gabapentinoids, and adjuvants in pain scores, opioid use and postoperative recovery. A systematic review research methodology and comparative quantitative analysis was used to evaluate the evidence in peer reviewed studies from 2018–2025. Data were collected from Science Citation Indexed (SCI) journals, PubMed, Web of science and Clinical anesthesia. The results show that multimodal non-opioid management is effective in providing better pain relief and reducing dependence on opioids after surgery. NSAIDs were very effective at reducing inflammatory pain, and opioid-sparing was significantly enhanced by the use of NSAIDs. Gabapentinoids were also found to help with the modulation of neuropathic pain and reducing central sensitization. When used as a supplement, ketamine and dexmedetomidine were very effective in high-risk surgical patients. A numerical analysis revealed a statistically significant reduction in opioid use, hospital length of stay and pain scores in patients receiving multimodal non-opioid protocols in contrast to opioid-based regimen. The study highlights that alternatives to opioids for pain in surgery are patient-centred, effective and evidence-based, and are recommended for modern surgery. The use of multimodal pharmacological protocols improves enhanced recovery pathways and reduces patient safety and long-term opioid related complications significantly.