Anesthetic management of postoperative pain in patients with chronic pain requires a thorough preoperative evaluation, including pain history, previous treatments, opioid use, physical and psychiatric comorbidities, and setting realistic patient expectations. It is essential to maintain baseline equianalgesic doses, especially of long-acting opioids, to avoid withdrawal symptoms, while adjusting short-acting opioid doses according to pain progression. Personalized multimodal analgesia is the cornerstone strategy, combining drugs such as acetaminophen, NSAIDs, gabapentinoids, NMDA antagonists, systemic local anesthetics, and alpha-2 agonists, along with regional techniques like epidural analgesia or peripheral nerve blocks, aiming to reduce opioid consumption and adverse effects. Preventive analgesia is used to avoid central sensitization, and cautious opioid use helps prevent opioid-induced hyperalgesia. Continuous monitoring of sedation, respiratory function, and pain assessment with validated scales is necessary, adjusting therapy accordingly, and, when appropriate, patient-controlled analgesia (PCA) devices can be employed. Finally, education and psychological support are important to improve pain perception, treatment adherence, and overall patient well-being. This comprehensive approach facilitates better postoperative pain control, reduces complications, and promotes faster and more functional recovery.
Guggiana Barrios, M. J. . (2025). Postoperative pain management in patients with chronic opioid use: a narrative review. Boletín De Anestesia, (5), pp. 1–8. Retrieved from https://boletinanestesia.uchile.cl/index.php/BA/article/view/81288
