Review

. 2022 Sep 21;17(1):50.

doi: 10.1186/s13017-022-00455-7.

Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines

Federico Coccolini¹, Francesco Corradi², Massimo Sartelli³, Raul Coimbra⁴, Igor A Kryvoruchko⁵, Ari Leppaniemi⁶, Krstina Doklestic⁷, Elena Bignami⁸, Giandomenico Biancofiore⁹, Miklosh Bala¹⁰, Ceresoli Marco¹¹, Dimitris Damaskos¹², Walt L Biffl¹³, Paola Fugazzola¹⁴, Domenico Santonastaso¹⁵, Vanni Agnoletti¹⁵, Catia Sbarbaro², Mirco Nacoti¹⁶, Timothy C Hardcastle¹⁷, Diego Mariani¹⁸, Belinda De Simone¹⁹, Matti Tolonen²⁰, Chad Ball²¹, Mauro Podda²², Isidoro Di Carlo²³, Salomone Di Saverio²⁴, Pradeep Navsaria²⁵, Luigi Bonavina²⁶, Fikri Abu-Zidan²⁷, Kjetil Soreide²⁸, Gustavo P Fraga²⁹, Vanessa Henriques Carvalho³⁰, Sergio Faria Batista³¹, Andreas Hecker³², Alessandro Cucchetti³³, Giorgio Ercolani³³, Dario Tartaglia³⁴, Joseph M Galante³⁵, Imtiaz Wani³⁶, Hayato Kurihara³⁷, Edward Tan³⁸, Andrey Litvin³⁹, Rita Maria Melotti⁴⁰, Gabriele Sganga⁴¹, Tamara Zoro², Alessandro Isirdi², Nicola De'Angelis⁴², Dieter G Weber⁴³, Adrien M Hodonou⁴⁴, Richard tenBroek⁴⁵, Dario Parini⁴⁶, Jim Khan⁴⁷, Giovanni Sbrana⁴⁸, Carlo Coniglio⁴⁹, Antonino Giarratano⁵⁰, Angelo Gratarola⁵¹, Claudia Zaghi⁵², Oreste Romeo⁵³, Michael Kelly⁵⁴, Francesco Forfori², Massimo Chiarugi³⁴, Ernest E Moore⁵⁵, Fausto Catena⁵⁶, Manu L N G Malbrain^{57

58}

Affiliations

¹ General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy. federico.coccolini@gmail.com.
² ICU Department, Pisa University Hospital, Pisa, Italy.
³ General Surgery Department, Macerata Hospital, Macerata, Italy.
⁴ Trauma Surgery Department, Riverside University Health System Medical Center, Loma Linda, CA, USA.
⁵ Department of Surgery No2, Kharkiv National Medical University, Kharkiv, Ukraine.
⁶ General Surgery Department, Helsinki University Hospital, Helsinki, Finland.
⁷ Clinic of Emergency Surgery, University Clinical Center of Serbia, Belgrade, Serbia.
⁸ ICU Department, Parma University Hospital, Parma, Italy.
⁹ Transplant ICU Department, Pisa University Hospital, Pisa, Italy.
¹⁰ Trauma and Acute Care Surgery Unit Hadassah, Hebrew University Medical Center, Jerusalem, Israel.
¹¹ General Surgery Department, Monza University Hospital, Monza, Italy.
¹² General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
¹³ Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA.
¹⁴ General Surgery Department, Pavia University Hospital, Pavia, Italy.
¹⁵ ICU Department, Bufalini Hospital, Cesena, Italy.
¹⁶ ICU Department Papa Giovanni XXIII Hospital, Bergamo, Italy.
¹⁷ Trauma and Burn Service, Inkosi Albert Luthuli Central Hospital, Mayville, Durban, South Africa.
¹⁸ General Surgery Department, Legnano Hospital, Legnano, Milano, Italy.
¹⁹ Emergency and Colorectal Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France.
²⁰ Emergency Surgery, HUS Helsinki University Hospital, Meilahti Tower Hospital, Helsinki, Finland.
²¹ Trauma and Acute Care Surgery, Foothills Medical Center, Calgary, AB, Canada.
²² Department of Surgical Science, University of Cagliari, Cagliari, Italy.
²³ General Surgery, Cannizzaro University Hospital, Catania, Italy.
²⁴ General Surgery Department, San Benedetto del Tronto Hospital, San Benedetto del Tronto, Italy.
²⁵ Trauma Center, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
²⁶ General Surgery Department, San Donato Hospital, Milan, Italy.
²⁷ Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
²⁸ Department of Gastrointestinal Surgery, Stavanger University Hospital, University of Bergen, Bergen, Norway.
²⁹ Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil.
³⁰ ICU Department, School of Medical Sciences, University of Campinas, Campinas, Brazil.
³¹ Anesthesia Department, School of Medical Sciences, Campinas, Brazil.
³² General Surgery, Giessen University Hospital, Giessen, Germany.
³³ Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, General Surgery of the Morgagni - Pierantoni Hospital, Forlì, Italy.
³⁴ General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy.
³⁵ General Surgery Department, UCLA Davis University Hospital, Los Angeles, CA, USA.
³⁶ General Surgery Department, Government Gousiua Hospital, Srinagar, India.
³⁷ Emergency and Trauma Surgery Department, Milano University Hospital, Milan, Italy.
³⁸ Emergency Department, Nijmegen Hospital, Nijmegen, The Netherlands.
³⁹ Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russia.
⁴⁰ Bologna University, Bologna, Italy.
⁴¹ Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
⁴² Service de Chirurgie Digestive Et Hépato-Bilio-Pancréatique, Hôpital Henri Mondor, Université Paris Est, Créteil, France.
⁴³ Department of General Surgery, Royal Perth Hospital, Perth, Australia.
⁴⁴ Faculty of Medicine of Parakou, University of Parakou, Parakou, Benin.
⁴⁵ General Surgery Department, Nijmegen Hospital, Nijmegen, The Netherlands.
⁴⁶ General Surgery Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy.
⁴⁷ University of Portsmouth, Portsmouth Hospitals University NHS Trust UK, Portsmouth, UK.
⁴⁸ ICU-HEMS Department, Arezzo Hospital, Arezzo, Italy.
⁴⁹ ICU Department, Maggiore Hospital, Bologna, Italy.
⁵⁰ ICU Department, P. Giaccone Hospital, Palermo, Italy.
⁵¹ ICU Department, San Martino Hospital, Genoa, Italy.
⁵² General, Emergency and Trauma Surgery Department, Vicenza Hospital, Vicenza, Italy.
⁵³ Trauma and Surgical Critical Care, East Medical Center Drive, University of Michigan Health System, Ann Arbor, MI, USA.
⁵⁴ Department of General Surgery, Albury Hospital, Albury, Australia.
⁵⁵ E. Moore Shock and Trauma Centre, Denver, CO, USA.
⁵⁶ General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
⁵⁷ First Department Anaesthesiology Intensive Therapy, Medical University Lublin, Lublin, Poland.
⁵⁸ International Fluid Academy, Lovenjoel, Belgium.

PMID: 36131311
PMCID: PMC9494880
DOI: 10.1186/s13017-022-00455-7

Review

Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines

Federico Coccolini et al. World J Emerg Surg. 2022.

. 2022 Sep 21;17(1):50.

doi: 10.1186/s13017-022-00455-7.

Authors

Affiliations

¹ General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy. federico.coccolini@gmail.com.
² ICU Department, Pisa University Hospital, Pisa, Italy.
³ General Surgery Department, Macerata Hospital, Macerata, Italy.
⁴ Trauma Surgery Department, Riverside University Health System Medical Center, Loma Linda, CA, USA.
⁵ Department of Surgery No2, Kharkiv National Medical University, Kharkiv, Ukraine.
⁶ General Surgery Department, Helsinki University Hospital, Helsinki, Finland.
⁷ Clinic of Emergency Surgery, University Clinical Center of Serbia, Belgrade, Serbia.
⁸ ICU Department, Parma University Hospital, Parma, Italy.
⁹ Transplant ICU Department, Pisa University Hospital, Pisa, Italy.
¹⁰ Trauma and Acute Care Surgery Unit Hadassah, Hebrew University Medical Center, Jerusalem, Israel.
¹¹ General Surgery Department, Monza University Hospital, Monza, Italy.
¹² General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
¹³ Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA.
¹⁴ General Surgery Department, Pavia University Hospital, Pavia, Italy.
¹⁵ ICU Department, Bufalini Hospital, Cesena, Italy.
¹⁶ ICU Department Papa Giovanni XXIII Hospital, Bergamo, Italy.
¹⁷ Trauma and Burn Service, Inkosi Albert Luthuli Central Hospital, Mayville, Durban, South Africa.
¹⁸ General Surgery Department, Legnano Hospital, Legnano, Milano, Italy.
¹⁹ Emergency and Colorectal Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France.
²⁰ Emergency Surgery, HUS Helsinki University Hospital, Meilahti Tower Hospital, Helsinki, Finland.
²¹ Trauma and Acute Care Surgery, Foothills Medical Center, Calgary, AB, Canada.
²² Department of Surgical Science, University of Cagliari, Cagliari, Italy.
²³ General Surgery, Cannizzaro University Hospital, Catania, Italy.
²⁴ General Surgery Department, San Benedetto del Tronto Hospital, San Benedetto del Tronto, Italy.
²⁵ Trauma Center, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
²⁶ General Surgery Department, San Donato Hospital, Milan, Italy.
²⁷ Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
²⁸ Department of Gastrointestinal Surgery, Stavanger University Hospital, University of Bergen, Bergen, Norway.
²⁹ Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil.
³⁰ ICU Department, School of Medical Sciences, University of Campinas, Campinas, Brazil.
³¹ Anesthesia Department, School of Medical Sciences, Campinas, Brazil.
³² General Surgery, Giessen University Hospital, Giessen, Germany.
³³ Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, General Surgery of the Morgagni - Pierantoni Hospital, Forlì, Italy.
³⁴ General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy.
³⁵ General Surgery Department, UCLA Davis University Hospital, Los Angeles, CA, USA.
³⁶ General Surgery Department, Government Gousiua Hospital, Srinagar, India.
³⁷ Emergency and Trauma Surgery Department, Milano University Hospital, Milan, Italy.
³⁸ Emergency Department, Nijmegen Hospital, Nijmegen, The Netherlands.
³⁹ Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russia.
⁴⁰ Bologna University, Bologna, Italy.
⁴¹ Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
⁴² Service de Chirurgie Digestive Et Hépato-Bilio-Pancréatique, Hôpital Henri Mondor, Université Paris Est, Créteil, France.
⁴³ Department of General Surgery, Royal Perth Hospital, Perth, Australia.
⁴⁴ Faculty of Medicine of Parakou, University of Parakou, Parakou, Benin.
⁴⁵ General Surgery Department, Nijmegen Hospital, Nijmegen, The Netherlands.
⁴⁶ General Surgery Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy.
⁴⁷ University of Portsmouth, Portsmouth Hospitals University NHS Trust UK, Portsmouth, UK.
⁴⁸ ICU-HEMS Department, Arezzo Hospital, Arezzo, Italy.
⁴⁹ ICU Department, Maggiore Hospital, Bologna, Italy.
⁵⁰ ICU Department, P. Giaccone Hospital, Palermo, Italy.
⁵¹ ICU Department, San Martino Hospital, Genoa, Italy.
⁵² General, Emergency and Trauma Surgery Department, Vicenza Hospital, Vicenza, Italy.
⁵³ Trauma and Surgical Critical Care, East Medical Center Drive, University of Michigan Health System, Ann Arbor, MI, USA.
⁵⁴ Department of General Surgery, Albury Hospital, Albury, Australia.
⁵⁵ E. Moore Shock and Trauma Centre, Denver, CO, USA.
⁵⁶ General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
⁵⁷ First Department Anaesthesiology Intensive Therapy, Medical University Lublin, Lublin, Poland.
⁵⁸ International Fluid Academy, Lovenjoel, Belgium.

PMID: 36131311
PMCID: PMC9494880
DOI: 10.1186/s13017-022-00455-7

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.

Keywords: Acute; Emergency; Morbidity; Pain; Surgery; Treatment.

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Conflict of interest statement

All authors declare to have no competing interests.

Figures

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References

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Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines

Affiliations

Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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LinkOut - more resources

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Medical