Guidelines for Complications of Cancer Treatment Vol VIII Part B

Multimodal Techniques for Pain ManagementAdministration of two analgesic agents that act by differentmechanisms via a single route provide superior analgesicefficacy with equivalent or reduced adverse effects.(Supportive evidence) The literature is insufficient toevaluate the postoperative analgesic effects of oral opioidscombined with nonsteroidal anti-inflammatory drugs(NSAIDs). The Task Force believes that NSAID, COXIB oracetaminophen administration has a dose-sparing effect forsystemically administered opioids. Two routes ofadministration, when compared with a single route, may bemore effective in providing perioperative analgesia.(Suggestive evidence) The literature is insufficient to evaluatethe efficacy of pharmacologic pain management combined withnonpharmacologic, alternative or complementary painmanagement when compared to pharmacologic painmanagement alone.Whenever possible, anesthesiologists should employmultimodal pain management therapy.Unless contraindicated, all patients should receive anaround-the-clock regimen of NSAIDs, COXIBs, oracetaminophen. In addition, regional blockade with localanesthetics should be considered.Dosing regimens should be administered to optimizeefficacy while minimizing the risk of adverse events.The choice of medication, dose, route, and duration oftherapy should be individualized.Patient SubpopulationsSome patient groups are at special risk for inadequate paincontrol, and require additional analgesic considerations.Patient populations at risk include (1) pediatric patients, (2)geriatric patients, and (3) critically ill or cognitively impaired59