Pain Management in Orthopedic Surgery: A Procedure-Specific Orthopedic-Anesthesia Approach to Perioperative Analgesia.
- 1Department of Orthopaedics, Paras HMRI Hospital, Patna, Bihar, India.
- 2Department of Orthopaedics, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
- 3Department of Anaesthesia, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Abstract
Introduction: Post-operative pain in orthopedic surgery is clinically important because inadequate analgesia can impair mobilization, sleep, physiotherapy and discharge, while excessive analgesia can cause sedation, motor weakness, drug toxicity and unnecessary opioid exposure. This narrative review uses a structured literature search of PubMed/MEDLINE and targeted review of recent systematic reviews, randomized trials, consensus statements and procedure-specific recommendations, with emphasis on publications available through September 2026. Evidence is synthesized qualitatively according to procedure, analgesic strategy, functional outcomes, and limitations of the underlying evidence. Present evidence supports multimodal analgesia, but does not support a universal regimen or routine addition of every available intervention. Regional techniques can improve early analgesia, although benefits vary by procedure and may be offset by motor block, rebound pain, or limitations in post-operative examination. A non-steroidal anti-inflammatory drugs (NSAIDs) provide opioid-sparing analgesia, but the relationship between NSAID exposure and fracture healing remains uncertain and appears to depend on drug, dose, duration, fracture type, and patient factors. Opioids remain appropriate as rescue therapy when clinically indicated. Persistent post-surgical pain is influenced by pre-operative and biopsychosocial factors and acute analgesia has not been shown consistently to prevent it. The practical framework proposed here therefore links the operation, patient risk profile, analgesic options, and rehabilitation task, with unexpected severe pain treated as a trigger for clinical reassessment rather than automatic escalation.
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BibTeX
@article{bhadani2026pain,
title = {{Pain Management in Orthopedic Surgery: A Procedure-Specific Orthopedic-Anesthesia Approach to Perioperative Analgesia.}},
author = {Janki Sharan Bhadani and Indrajeet Kumar and Priyanka Kumari and Akhileshwar and Nishant Kashyap and Santosh Kumar},
journal = {Journal of orthopaedic case reports},
year = {2026},
month = nov,
doi = {10.13107/jocr.2026.v16.i11.8558},
url = {https://europepmc.org/article/MED/42997146},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Pain Management in Orthopedic Surgery: A Procedure-Specific Orthopedic-Anesthesia Approach to Perioperative Analgesia.
AU - Janki Sharan Bhadani
AU - Indrajeet Kumar
AU - Priyanka Kumari
AU - Akhileshwar
AU - Nishant Kashyap
AU - Santosh Kumar
PY - 2026
DA - 2026/11/01
JO - Journal of orthopaedic case reports
DO - 10.13107/jocr.2026.v16.i11.8558
UR - https://europepmc.org/article/MED/42997146
AB - Introduction: Post-operative pain in orthopedic surgery is clinically important because inadequate analgesia can impair mobilization, sleep, physiotherapy and discharge, while excessive analgesia can cause sedation, motor weakness, drug toxicity and unnecessary opioid exposure. This narrative review uses a structured literature search of PubMed/MEDLINE and targeted review of recent systematic reviews, randomized trials, consensus statements and procedure-specific recommendations, with emphasis on publications available through September 2026. Evidence is synthesized qualitatively according to procedure, analgesic strategy, functional outcomes, and limitations of the underlying evidence. Present evidence supports multimodal analgesia, but does not support a universal regimen or routine addition of every available intervention. Regional techniques can improve early analgesia, although benefits vary by procedure and may be offset by motor block, rebound pain, or limitations in post-operative examination. A non-steroidal anti-inflammatory drugs (NSAIDs) provide opioid-sparing analgesia, but the relationship between NSAID exposure and fracture healing remains uncertain and appears to depend on drug, dose, duration, fracture type, and patient factors. Opioids remain appropriate as rescue therapy when clinically indicated. Persistent post-surgical pain is influenced by pre-operative and biopsychosocial factors and acute analgesia has not been shown consistently to prevent it. The practical framework proposed here therefore links the operation, patient risk profile, analgesic options, and rehabilitation task, with unexpected severe pain treated as a trigger for clinical reassessment rather than automatic escalation.
SN - 2250-0685
SN - 2321-3817
ER -