A Otimização do manejo da dor e recuperação pós-operatória em cirurgias abdominais de grande porte

Abstract

This article reviews the scientific literature on optimizing pain management and postoperative recovery in patients undergoing major abdominal surgery, focusing on comparing different analgesic approaches and perioperative protocols, as well as their implications for clinical outcomes. The search was conducted in the PubMed, Scopus, and Web of Science databases, using the descriptors "Postoperative Pain Management," "Enhanced Recovery After Surgery," "Major Abdominal Surgery," and "Multimodal Analgesia." The analysis of the studies reveals that the implementation of Enhanced Recovery After Surgery (ERAS) protocols, combined with specific analgesic strategies, significantly influences the reduction in hospital stay, the reduction in complications, and the rapid recovery of bowel function. Multimodal analgesia, which combines different pharmacological classes (e.g., NSAIDs, paracetamol, gabapentinoids) to spare opioids, has been shown to be superior to analgesia based primarily on systemic opioids. Furthermore, regional anesthesia techniques, such as thoracic epidural analgesia and fascial plane blocks (e.g., transversus abdominis plane block - TAP), have been shown to attenuate the surgical stress response and provide more effective pain control, facilitating early mobilization. Recent studies also highlight the potential of adjuvants, such as intravenous lidocaine and low-dose ketamine, to reduce opioid-induced hyperalgesia and the incidence of chronic pain. Understanding these integrated approaches is essential for the development of safer and more personalized perioperative strategies capable of minimizing the physiological impact of surgery and accelerating the patient's functional recovery.