How should intraoperative analgesia be scheduled to minimize postoperative pain?

• A. Postoperative analgesia only.
• B. No analgesia until after surgery.
• C. Only intraoperative analgesia with opioids.
• D. Preemptive and ongoing intraoperative analgesia with multimodal agents, followed by structured postoperative analgesia.

Answer: (D)

Blunting pain before it starts and sustaining it through the intraoperative period, then continuing with a well-planned postoperative plan, is the most effective way to minimize postoperative pain. Preemptive analgesia uses medications before the incision to dampen afferent nociceptive input, which reduces central sensitization and wind-up that can amplify pain after surgery. Continuing intraoperative analgesia with a multimodal approach means targeting different pain pathways — using opioids alongside non-opioid drugs, local anesthetics, NMDA antagonists, alpha-2 agonists, lidocaine or ketamine infusions, etc. This strategy lowers the total opioid dose needed, minimizes opioid-related side effects, and provides smoother pain control during and after the procedure. Following the surgery with a structured analgesia plan ensures ongoing comfort during recovery, helps prevent breakthrough pain, and supports a calmer, less stressful recovery consistent with Fear Free goals.

Options that wait to treat pain after surgery, or rely on a single modality (like only intraoperative opioids, or no preemptive plan), miss the preventive and multi-pathway benefits, leading to higher postoperative pain and analgesic needs.