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

A comprehensive search for guidelines was done to identify the most relevant ones to consider for adaptation. For the literature review, potentially relevant clinical studies were identified via electronic and manual searches of the literature. The updated searches covered almost 5-year period from January 1, 2020, to May 31, 2026. The inclusion/exclusion criteria that were followed in the search and retrieval of guidelines are adapted.

We selected guidelines only if they are:

-  Evidence-based guidelines.

-  National and/or international guidelines.

-  Guidelines published within the last 5 years.

-  Peer reviewed publications.

-  Guidelines written in English language.

We Excluded guidelines that are:

-  Written by a single author not on behalf of an organization as guideline to be valid and comprehensive, ideally requires multidisciplinary input.

-  Published without references as the GDG panel needs to know whether a thorough literature review was conducted and whether the current evidence was used in the preparation of the recommendations.

All retrieved Guidelines were screened and appraised using AGREE II instrument (www.agreetrust.org) by at least three members of the GDG. The panel decided on a cut-off point or ranked the guidelines (any guideline scoring above 50% on the rigor dimension was retained).

Guidelines used in the Adaptation Process:

The basic elements of the Practice Guideline for Perioperative Pain Management Using Local and Regional Analgesia for Cardiothoracic Surgeries, Mastectomy, and Abdominal Surgeries in adults and children published by ASA can be successfully implemented in the practice of anesthesiology. The Guidelines Development Group (GDG) for the Egyptian Board of Anesthetics, Surgical Intensive Care, and Pain Management has adopted with modification:

1.      Joshi, GP, Mariano; Elkassabany, et al. 2026 American Society of Anesthesiologists Practice Guideline on Perioperative Pain Management Using Local and Regional Analgesia for Cardiothoracic Surgeries, Mastectomy, and Abdominal Surgeries. Anesthesiology 144(1):p 19-43, January 2026.

(Reference No. 1)

2.      Joshi GP, Kehlet H, Lobo DN: Nonsteroidal anti-inflammatory drugs in the perioperative period: Current controversies and concerns. Br J Anaesth 2025; 134:294–6. (Reference No. 3)

3.      El-Boghdadly K, Levy NA, Fawcett WJ, et al.: Peri-operative pain management in adults: A multidisciplinary consensus statement from the Association of Anaesthetists and the British Pain Society. Anaesthesia 2024; 79:1220–36. (Reference No. 4)

4.      Wong HY, Pilling R, Young BWM, Owolabi AA, Onwochei DN, Desai N: Comparison of local and regional anesthesia modalities in breast surgery: A systematic review and network meta-analysis. J Clin Anesth 2021; 72:110274. (Reference No. 27)

5.      Southwell B, Brandt S, Choconta-Piraquive LA, et al.: Peripheral nerve blocks for postoperative pain management in cardiothoracic surgery. Systematic review (prepared by Minnesota evidence-based practice center under contract no. 75q80124f32011), 2025. Agency for Healthcare Research and Quality, Rockville, Maryland. Report No. 25-EHC028. Available at: https://effectivehealthcare.ahrq.gov/products/peripheral-nerve-blocks/research. Accessed September 24, 2025. (Reference No. 28)

    ➡️Strength of Recommendations

The strength of a recommendation communicates the importance of adherence to the recommendation.