Optimizing pain management Transition from acute to chronic pain

The aim of this thesis was to contribute to advancements in pain management within the perioperative setting.
In part I, an overview of the literature was provided, focusing on innovative, multidisciplinary, and patient-tailored approaches to prevent the development of chronic postsurgical pain (CPSP). Furthermore, the TRUSt study with 176 patients showed that a Transitional Pain Service (TPS) did not impact immediate recovery after surgery, but long-term outcomes, including opioid reduction, and reduced disability, could benefit from TPS involvement. Healthcare providers expressed satisfaction and desired continued TPS implementation.
Part II examined the use of perioperative peripheral nerve blocks, reviewing literature on the most common nerve blocks and their effectiveness on acute postoperative pain. In addition, two randomized controlled trials were conducted. The initial trial showed comparable readiness for discharge in patients undergoing anterior cruciate ligament reconstruction irrespective of whether they received a femoral nerve block or adductor canal block. Subsequently, the CAREFREE trial demonstrated that ambulatory continuous popliteal sciatic nerve blockade was non-inferior to standard of care with single shot popliteal sciatic nerve blockade on patient-reported overall benefit of analgesia.
Finally, part III explored the unique pain experiences and treatment options for specific patient populations. First, potential age-related risk factors associated with acute postoperative pain were explored in older patients, revealing no difference between patients with and without disability. Second, neuraxial analgesia seems to be the most effective strategy in reducing acute postoperative pain in pediatric patients undergoing major abdominal surgery for intractable functional constipation. Last, the implementation of the multimodal pain protocol was feasible and enabled prompt administration of opioids in patients with sickle cell disease who experienced severe episodes of pain during vaso-occlusive crisis.