Perioperative Pain Management Using Local and Regional Analgesia for Cardiothoracic Surgeries, Mastectomy, and Abdominal Surgeries in Adults and Children

- Introduction

A multimodal analgesic strategy improves postoperative pain relief and reduces opioid requirements. Given that the recommendations for systemic analgesics are consistent for all surgical patients and procedures, the only component of an optimal multimodal analgesia strategy that remains variable is the use of regional analgesia and surgical site local anesthetic infiltration techniques. Therefore, the ASA Task Force on Perioperative Pain Management focused their systematic review [1] on procedure-specific regional/local analgesia techniques. Because pain is a complex and multifactorial phenomenon, a multimodal analgesic regimen that leverages a combination of nonopioid analgesics with different mechanisms of action is recommended [2]. While optimal analgesic combinations remain elusive, routine use of the combination of acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), or cyclooxygenase (COX)–2 specific inhibitors have been recommended unless there are contraindications [3].

Postoperative pain is often accompanied by physiologic and psychological stress responses with short-term and long-term consequences. Optimal perioperative pain management facilitates postoperative functional recovery (e.g., ambulation and rehabilitation) and thus is considered a prerequisite to enhancing recovery after surgery [2,4]. Postoperative pain is a major concern reported by most surgical patients. Inadequate postoperative pain management is associated with chronic postsurgical pain, which can affect long-term quality of life. Unfortunately, there is a disturbingly high rate of suboptimal pain control with approximately 75% of surgical patients experiencing moderate to severe pain [5].

This practice guideline provides evidence-based recommendations for perioperative pain management in adults and children undergoing cardiothoracic surgeries, mastectomy, and abdominal surgeries in adults and children. The guidance focuses on local and regional analgesia - key components of an optimal multimodal analgesia regimen.

The Egyptian Guidelines were made in accordance with the 2026 American Society of Anesthesiologists Practice Guideline on Perioperative Pain Management Using Local and Regional Analgesia for Cardiothoracic Surgeries, Mastectomy, and Abdominal Surgeries. Joshi, GP, Mariano; Elkassabany, et al. Anesthesiology 144(1):p 19-43, January 2026. [1]