Different Modalities of Perioperative Pain Management

Despite major advances in anaesthesia, surgical techniques, and perioperative care pathways, perioperative pain remains a significant clinical problem and a key determinant of post-operative recovery, morbidity, length of hospital stay, and patient satisfaction. Inadequate pain control is associated with impaired mobilisation, pulmonary complications, prolonged ileus, increased risk of thromboembolism, and the development of chronic post-surgical pain. Historically, perioperative analgesia has relied heavily on opioids; however, opioid-related adverse effects, including respiratory depression, nausea, ileus, delirium, tolerance, hyperalgesia, and long-term dependence, have driven a global shift towards multi-modal, opioid-sparing strategies. Contemporary perioperative practice now emphasizes individualised, mechanism-based, and function-oriented analgesia rather than pain score reduction alone. This chapter provides a comprehensive review of modern modalities of perioperative pain management, including non-opioid and opioid pharmacotherapy, adjuvant analgesics, regional and local anaesthetic techniques, and non-pharmacologic interventions. The integration of these modalities within enhanced recovery after surgery (ERAS) pathways and opioid stewardship frameworks is discussed. Special populations and high-risk patients are addressed, and practical clinical examples are provided to facilitate implementation in diverse surgical settings.