World Journal of Emergency Surgery (Sep 2022)
Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines
- Federico Coccolini,
- Francesco Corradi,
- Massimo Sartelli,
- Raul Coimbra,
- Igor A. Kryvoruchko,
- Ari Leppaniemi,
- Krstina Doklestic,
- Elena Bignami,
- Giandomenico Biancofiore,
- Miklosh Bala,
- Ceresoli Marco,
- Dimitris Damaskos,
- Walt L. Biffl,
- Paola Fugazzola,
- Domenico Santonastaso,
- Vanni Agnoletti,
- Catia Sbarbaro,
- Mirco Nacoti,
- Timothy C. Hardcastle,
- Diego Mariani,
- Belinda De Simone,
- Matti Tolonen,
- Chad Ball,
- Mauro Podda,
- Isidoro Di Carlo,
- Salomone Di Saverio,
- Pradeep Navsaria,
- Luigi Bonavina,
- Fikri Abu-Zidan,
- Kjetil Soreide,
- Gustavo P. Fraga,
- Vanessa Henriques Carvalho,
- Sergio Faria Batista,
- Andreas Hecker,
- Alessandro Cucchetti,
- Giorgio Ercolani,
- Dario Tartaglia,
- Joseph M. Galante,
- Imtiaz Wani,
- Hayato Kurihara,
- Edward Tan,
- Andrey Litvin,
- Rita Maria Melotti,
- Gabriele Sganga,
- Tamara Zoro,
- Alessandro Isirdi,
- Nicola De’Angelis,
- Dieter G. Weber,
- Adrien M. Hodonou,
- Richard tenBroek,
- Dario Parini,
- Jim Khan,
- Giovanni Sbrana,
- Carlo Coniglio,
- Antonino Giarratano,
- Angelo Gratarola,
- Claudia Zaghi,
- Oreste Romeo,
- Michael Kelly,
- Francesco Forfori,
- Massimo Chiarugi,
- Ernest E. Moore,
- Fausto Catena,
- Manu L. N. G. Malbrain
Affiliations
- Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital
- Francesco Corradi
- ICU Department, Pisa University Hospital
- Massimo Sartelli
- General Surgery Department, Macerata Hospital
- Raul Coimbra
- Trauma Surgery Department, Riverside University Health System Medical Center
- Igor A. Kryvoruchko
- Department of Surgery No2, Kharkiv National Medical University
- Ari Leppaniemi
- General Surgery Department, Helsinki University Hospital
- Krstina Doklestic
- Clinic of Emergency Surgery, University Clinical Center of Serbia
- Elena Bignami
- ICU Department, Parma University Hospital
- Giandomenico Biancofiore
- Transplant ICU Department, Pisa University Hospital
- Miklosh Bala
- Trauma and Acute Care Surgery Unit Hadassah, Hebrew University Medical Center
- Ceresoli Marco
- General Surgery Department, Monza University Hospital
- Dimitris Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh
- Walt L. Biffl
- Trauma/Acute Care Surgery, Scripps Clinic Medical Group
- Paola Fugazzola
- General Surgery Department, Pavia University Hospital
- Domenico Santonastaso
- ICU Department, Bufalini Hospital
- Vanni Agnoletti
- ICU Department, Bufalini Hospital
- Catia Sbarbaro
- ICU Department, Pisa University Hospital
- Mirco Nacoti
- ICU Department Papa Giovanni XXIII Hospital
- Timothy C. Hardcastle
- Trauma and Burn Service, Inkosi Albert Luthuli Central Hospital
- Diego Mariani
- General Surgery Department, Legnano Hospital
- Belinda De Simone
- Emergency and Colorectal Surgery, Poissy and Saint Germain en Laye Hospitals
- Matti Tolonen
- Emergency Surgery, HUS Helsinki University Hospital, Meilahti Tower Hospital
- Chad Ball
- Trauma and Acute Care Surgery, Foothills Medical Center
- Mauro Podda
- Department of Surgical Science, University of Cagliari
- Isidoro Di Carlo
- General Surgery, Cannizzaro University Hospital
- Salomone Di Saverio
- General Surgery Department, San Benedetto del Tronto Hospital
- Pradeep Navsaria
- Trauma Center, Groote Schuur Hospital, University of Cape Town
- Luigi Bonavina
- General Surgery Department, San Donato Hospital
- Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University
- Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, University of Bergen
- Gustavo P. Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas
- Vanessa Henriques Carvalho
- ICU Department, School of Medical Sciences, University of Campinas
- Sergio Faria Batista
- Anesthesia Department, School of Medical Sciences
- Andreas Hecker
- General Surgery, Giessen University Hospital
- Alessandro Cucchetti
- Department of Medical and Surgical Sciences – DIMEC, Alma Mater Studiorum - University of Bologna, General Surgery of the Morgagni - Pierantoni Hospital
- Giorgio Ercolani
- Department of Medical and Surgical Sciences – DIMEC, Alma Mater Studiorum - University of Bologna, General Surgery of the Morgagni - Pierantoni Hospital
- Dario Tartaglia
- General, Emergency and Trauma Surgery Department, Pisa University Hospital
- Joseph M. Galante
- General Surgery Department, UCLA Davis University Hospital
- Imtiaz Wani
- General Surgery Department, Government Gousiua Hospital
- Hayato Kurihara
- Emergency and Trauma Surgery Department, Milano University Hospital
- Edward Tan
- Emergency Department, Nijmegen Hospital
- Andrey Litvin
- Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital
- Rita Maria Melotti
- Bologna University
- Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore
- Tamara Zoro
- ICU Department, Pisa University Hospital
- Alessandro Isirdi
- ICU Department, Pisa University Hospital
- Nicola De’Angelis
- Service de Chirurgie Digestive Et Hépato-Bilio-Pancréatique, Hôpital Henri Mondor, Université Paris Est
- Dieter G. Weber
- Department of General Surgery, Royal Perth Hospital
- Adrien M. Hodonou
- Faculty of Medicine of Parakou, University of Parakou
- Richard tenBroek
- General Surgery Department, Nijmegen Hospital
- Dario Parini
- General Surgery Department, Santa Maria Della Misericordia Hospital
- Jim Khan
- University of Portsmouth, Portsmouth Hospitals University NHS Trust UK
- Giovanni Sbrana
- ICU-HEMS Department, Arezzo Hospital
- Carlo Coniglio
- ICU Department, Maggiore Hospital
- Antonino Giarratano
- ICU Department, P. Giaccone Hospital
- Angelo Gratarola
- ICU Department, San Martino Hospital
- Claudia Zaghi
- General, Emergency and Trauma Surgery Department, Vicenza Hospital
- Oreste Romeo
- Trauma and Surgical Critical Care, East Medical Center Drive, University of Michigan Health System
- Michael Kelly
- Department of General Surgery, Albury Hospital
- Francesco Forfori
- ICU Department, Pisa University Hospital
- Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital
- Ernest E. Moore
- E. Moore Shock and Trauma Centre
- Fausto Catena
- General, Emergency and Trauma Surgery Department, Bufalini Hospital
- Manu L. N. G. Malbrain
- First Department Anaesthesiology Intensive Therapy, Medical University Lublin
- DOI
- https://doi.org/10.1186/s13017-022-00455-7
- Journal volume & issue
-
Vol. 17,
no. 1
pp. 1 – 15
Abstract
Abstract Background Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. Material and methods An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. Conclusion Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies.
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