Perioperative Pain Overview

Principles

Definition

Perioperative pain is the research field dedicated to the comprehensive study of pain phenomena occurring in relation to surgical procedures, spanning the preoperative, intraoperative, and postoperative periods. This domain investigates its underlying mechanisms, optimal assessment strategies, effective prevention methods, and advanced management techniques, recognizing its profound influence on patient morbidity, recovery, and healthcare resource utilization.

Ontological type

Analgesic Strategies

Outcomes and Complications

Pain Mechanisms

Key developments

Key Figures

Neuraxial and Preemptive Analgesia era

Joel Katz [1] was a leading figure during the neuraxial and preemptive analgesia era (1978-1995), with affiliations at Johns Hopkins University [2] and Yale University [3]. His 1992 paper Preemptive Analgesia Clinical Evidence of Neuroplasticity Contributing to Postoperative Pain [4] articulated how preemptive analgesia could modulate neuroplastic changes and central sensitization, providing a mechanistic rationale for standardized preemptive regimens in this era. Katz's work at Johns Hopkins University [2] and Yale University [3] helped translate mechanistic preemptive analgesia concepts into practice during this era. By articulating that preemptive analgesia can blunt central sensitization, Katz reinforced the era’s prevention-focused foundation for perioperative pain management as documented by the 1992 paper Preemptive Analgesia Clinical Evidence of Neuroplasticity Contributing to Postoperative Pain [4].

Preoperative Multimodal Optimization era

Paul S. Myles[1] is associated with Harvard University[3] and the Chinese University of Hong Kong[4] during the Preoperative Multimodal Optimization era. One of his key contributions in this era is the randomized trial Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial[7], which showed that incorporating regional analgesia can improve postoperative outcomes and pain control, thereby informing proactive preoperative multimodal strategies. Cor J. Kalkman[2] is associated with Radboud University Nijmegen[5] and Heidelberg University[6] during this era. His contribution centers on the paper Preoperative prediction of severe postoperative pain[8], which advanced risk stratification and predictive modeling to tailor preoperative analgesia, a foundational element of the era's outcome-driven optimization.

Standardized Multimodal ERAS era

Christopher L. Wu [1] has been a leading clinician-scientist during the Standardized Multimodal ERAS era, with affiliations at University of California, San Francisco [3] and Stanford University [4]. His key contributions in this era center on the 2016 guideline Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council [7], which consolidates multimodal analgesia and regional techniques to standardize perioperative care and reduce opioid exposure. Timothy J. Brennan [2] is likewise a prominent figure during this era, with affiliations at Johns Hopkins University [5] and University of Pennsylvania [6]. The 2016 guideline [7], co-authored by Brennan and colleagues, advanced standardized, opioid-sparing regimens within ERAS and integrated ultrasound-guided regional analgesia, reshaping perioperative pain management across surgical specialties.