In the U.S., opioid analgesics have been the cornerstone of postoperative pain management, driven by earlier efforts to improve treatment of pain and societal expectations for surgical recovery. Suboptimal postoperative pain management is associated with worsened humanistic and economic outcomes, including the development of chronic pain and opioid dependence. Despite tremendous benefits to survival and quality of life, surgical procedures frequently result in acute pain, among other risks. Surgery is an indispensable part of healthcare, and over 300 million surgical procedures are performed around the world annually. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. We then review recommended modalities at each phase of perioperative care. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing.
Surgical procedures are key drivers of pain development and opioid utilization globally.