Central sensitization and opioid-sparing multimodal analgesia: An editorial perspective on restructuring perioperative pain management

i

This article has been updated. A Correction to this article was published on .

i

The Original Article was published on

i

The Original Article was published on

i

This article has been updated

i

This article was retracted on

i

This article has been updated

Keywords

Multimodal analgesia / Opioid-sparing anesthesia / Perioperative pain management / Enhanced recovery after surgery / Postoperative pain / Central sensitization

CHANGE HISTORY

A Correction to this paper has been published:
https://doi.org

The Retraction Note was updated to reflect reception of statements of disagreement from all authors.

This article has been retracted.Please see the Retraction Notice for more detail:
https://doi.org

References

[1] Brummett CM, Waljee JF, Goesling J, et al. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2017; 152(6):e170504. https://doi.org/10.1001/jamasurg.2017.0504

[2] Chou R, Gordon DB, de Leon—Casasola OA, et al. 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. J Pain. 2016; 17(2):131-157. https://doi.org/10.1016/j.jpain.2015.12.008

[3] El—Boghdadly K, Levy NA, Fawcett WJ, et al. Peri—operative pain management in adults: a multidisciplinary consensus statement from the Association of Anaesthetists and the British Pain Society. Anaesthesia. 2024; 79(11):1220-1236. https://doi.org/10.1111/anae.16391

[4] Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011; 152(3 Suppl):S2-S15. https://doi.org/10.1016/j.pain.2010.09.030

[5] Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006; 367(9522):1618-1625. https://doi.org/10.1016/S0140—6736(06)68700—X

[6] Schwenk ES, Mariano ER. Designing the ideal perioperative pain management plan starts with multimodal analgesia. Korean J Anesthesiol. 2018; 71(5):345-352. https://doi.org/10.4097/kja.d.18.00217

[7] Joshi GP, Mariano ER, Elkassabany NM, et al. 2026 American Society of Anesthesiologists practice guideline on perioperative pain management using local and regional analgesia for cardiothoracic surgeries, mastectomy, and abdominal surgeries. Anesthesiology. 2026; 144(1):19-43. https://doi.org/10.1097/ALN.0000000000005790

[8] Hah JM, Bateman BT, Ratliff J, Curtin C, Sun E. Chronic opioid use after surgery: implications for perioperative management in the face of the opioid epidemic. Anesth Analg. 2017; 125(5):1733-1740. https://doi.org/10.1213/ANE.0000000000002458

[9] Park CM, Inouye SK, Marcantonio ER, et al. Perioperative gabapentin use and in—hospital adverse clinical events among older adults after major surgery. JAMA Intern Med. 2022; 182(11):1117-1127. https://doi.org/10.1001/jamainternmed.2022.3680

[10] Abouarab AH, Brülle R, Aboukilila MY, Weibel S, Schnabel A. Efficacy and safety of perioperative ketamine for the prevention of chronic postsurgical pain: a meta—analysis. Pain Pract. 2024; 24(3):553-566. https://doi.org/10.1111/papr.13314

[11] Verret M, Lauzier F, Zarychanski R, et al. Perioperative use of gabapentinoids for the management of postoperative acute pain: a systematic review and meta—analysis. Anesthesiology. 2020; 133(2):265-279. https://doi.org/10.1097/ALN.0000000000003428

[12] Brinck ECV, Tiippana E, Heesen M, et al. Perioperative intravenous ketamine for acute postoperative pain in adults. Cochrane Database Syst Rev. 2018;12(12):CD012033. https://doi.org/10.1002/14651858.CD012033.pub4

[13] Blaudszun G, Lysakowski C, Elia N, Tramèr MR. Effect of perioperative systemic α2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta—analysis of randomized controlled trials. Anesthesiology. 2012; 116(6):1312-1322. https://doi.org/10.1097/ALN.0b013e31825681cb

[14] Weibel S, Jelting Y, Pace NL, et al. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults. Cochrane Database Syst Rev. 2018;6(6):CD009642. https://doi.org/10.1002/14651858.CD009642.pub3

[15] Mayoral Rojals V, Charaja M, De Leon Casasola O, Montero A, Narvaez Tamayo MA, Varrassi G. New insights into the pharmacological management of postoperative pain: a narrative review. Cureus. 2022; 14(3):e23037. https://doi.org/10.7759/cureus.23037

[16] Stark PA, Myles PS, Burke JA. Development and psychometric evaluation of a postoperative quality of recovery score: the QoR—15. Anesthesiology. 2013; 118(6):1332-1340. https://doi.org/10.1097/ALN.0b013e318289b84b

[17] Myles PS, Shulman MA, Reilly J, Kasza J, Romero L. Measurement of quality of recovery after surgery using the 15—item quality of recovery scale: a systematic review and meta—analysis. Br J Anaesth. 2022; 128(6):1029-1039. https://doi.org/10.1016/j.bja.2022.03.009

[18] Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997; 78(5):606-617. https://doi.org/10.1093/bja/78.5.606

[19] Angst MS, Clark JD. Opioid—induced hyperalgesia: a qualitative systematic review. Anesthesiology. 2006; 104(3):570-587. https://doi.org/10.1097/00000542—200603000—00025

[20] Joshi GP, Kehlet H. PROSPECT Working Group. Guidelines for perioperative pain management: need for re—evaluation. Br J Anaesth. 2017; 119(4):720-722. https://doi.org/10.1093/bja/aex304

[21] Ryu G, Choi JM, Seok HS, et al. Machine learning based quantitative pain assessment for the perioperative period. NPJ Digit Med. 2025; 8(1):53. https://doi.org/10.1038/s41746—024—01362—8