Table 2.

A brief summary of ASA guidelines for acute perioperative pain management

Area	Recommendations
Institutional policies and procedures	Training and education of health care providers Monitoring patient outcomes and documentation Monitoring patient outcomes at institutional level Round-the-clock availability of anesthesiologists for perioperative pain management based on standardized institutional policies and procedures Use of APS
Preoperative evaluation of the patient	Preoperative assessment and individualized plan (based on type of surgery, anticipated pain levels, underlying conditions, risk/benefit of various analgesics, and patient preferences) Physical examination and patient history
Preoperative preparation of the patient	Adjustments or continuations of any medications that should not be discontinued because of possible withdrawal symptoms Treatments to reduce preexisting pain Treatment to relieve anxiety Premedications as part of a multimodal pain management program Patient and family/caregiver education, including behavioral pain control techniques
Perioperative pain management	May include, but is not limited to, central regional opioid analgesia, PCA with systemic opioid agents, and peripheral regional analgesia The abovementioned modalities should be given preference over intramuscular opioids “as needed” Selections must reflect the expertise of the anesthesiology team and the capacity for safe application at the practice setting Exercise caution with continuous infusion modalities
Multimodal pain management	Whenever possible, multimodal analgesic techniques should be used, such as central regional blockade with local anesthetics Unless contraindicated, patients should receive round-the-clock NSAIDs, coxibs, or acetaminophen All dosing should optimize efficacy while minimizing the risk of adverse events The choice of medication must be individualized (agent, dose, route, and duration of therapy)

Note: There are varying levels of evidence for these steps.

Abbreviations: ASA, American Society of Anesthesiologists; APS, acute pain service; NSAIDs, nonsteroidal anti-inflammatory drugs; PCA, patient-controlled analgesia.