Postoperative Pain Management in General Surgery: A Review of Current Protocols and Challenges

Abstract

Background: One of the main pillars of enhanced recovery after surgery (ERAS) continues to be effective postoperative pain management. In general, surgical patients, poor pain management endures despite the availability of multimodal analgesia and changing protocols, frequently resulting in postponed mobilization, extended hospital stays, and a lower quality of life.

Objective: Reviewing current postoperative pain management protocols in general surgery, highlighting the advantages and disadvantages of current approaches, and identifying new difficulties in improving patient outcomes are the goals of this study.

Methods: The evidence from recent randomized controlled trials, systematic reviews, clinical guidelines, and consensus statements published between 2015 and 2025 was synthesized to conduct a narrative review. The Cochrane Library, PubMed, and Scopus were among the sources. Included were studies on regional anesthesia methods, opioid-sparing regimens, multimodal analgesia, and ERAS protocols in general surgery.

Results: Multimodal analgesia, which combines non-opioid drugs like NSAIDs, acetaminophen, and gabapentinoids with regional anesthesia techniques like transversus abdominis plane (TAP) blocks and epidural analgesia for specific procedures, is supported by current research. Opioid-sparing regimens improve recovery and lessen side effects, but the best combinations depend on the particular procedure. Individual differences in pain perception, limited resources in low- and middle-income environments, inconsistent adherence to guidelines, and worries about chronic opioid dependence are some of the difficulties. Although they need more research, recent developments like liposomal local anesthetics, customized analgesia, and the incorporation of digital health tools show promise.

Conclusion: Although multimodal and opioid-sparing postoperative pain management has advanced significantly, implementation issues, patient variability, and striking a balance between safety and efficacy still exist. Individualized pain protocols, broader ERAS principle adoption, and evidence-based integration of new analgesic technologies should be the main focuses of future strategies.