Role of Multimodal Analgesia in the Evolving Enhanced Recovery after Surgery Pathways

Medicina (Kaunas). 2018 Apr 23;54(2):20. doi: 10.3390/medicina54020020.


Enhanced recovery after surgery (ERAS) are specially designed multimodal perioperative care pathways which are intended to attain and improve rapid recovery after surgical interventions by supporting preoperative organ function and attenuating the stress response caused by surgical trauma, allowing patients to get back to normal activities as soon as possible. Evidence-based protocols are prepared and published to implement the conception of ERAS. Although they vary amongst health care institutions, the main three elements (preoperative, perioperative, and postoperative components) remain the cornerstones. Postoperative pain influences the quality and length of the postoperative recovery period, and later, the quality of life. Therefore, the optimal postoperative pain management (PPM) applying multimodal analgesia (MA) is one of the most important components of ERAS. The main purpose of this article is to discuss the concept of MA in PPM, particularly reviewing the use of opioid-sparing measures such as paracetamol, nonsteroid anti-inflammatory drugs (NSAIDs), other adjuvants, and regional techniques.

Keywords: NSAIDs; enhanced recovery after surgery; multimodal analgesia; postoperative pain.

Publication types

  • Review

MeSH terms

  • Acetaminophen / therapeutic use*
  • Analgesia / methods*
  • Analgesia, Epidural
  • Analgesics, Opioid / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Chemotherapy, Adjuvant
  • Humans
  • Pain Management / methods*
  • Pain, Postoperative / drug therapy*
  • Postoperative Care / methods*


  • Analgesics, Opioid
  • Anti-Inflammatory Agents, Non-Steroidal
  • Acetaminophen